J12 MAC Transition
(* = off-site link)
Welcome to the J12 MAC Local Coverage Determination (LCD) transition webpage!
This page will serve as the J12 “home page” for LCD and LCD related items during the MAC J12 Transition period. Please begin here when you are looking for such information.
Local Coverage Determinations (LCDs)
Medicare contractors may establish medical coverage policies, known as Local Coverage Determinations (LCDs), pertinent to their areas of jurisdiction. The primary authority for such determinations is the Social Security Act. The Medicare Program Integrity Manual, CMS Publication IOM 100-08, Chapter 13, gives detailed instructions on LCDs.
Section 522 of the Benefits Improvement and Protection Act (BIPA) created the term “Local Coverage Determination” (LCD). An LCD is a decision by a Medicare contractor whether to cover a particular item or service on a contractor-wide basis in accordance with Section 1862(a)(1)(A) of the Social Security Act (i.e., a determination as to whether the item or service is reasonable and necessary). LCDs are administrative and educational tools to assist providers in submitting correct claims for payment.
LCDs, as opposed to the prior Local Medical Review Policies (LMRPs), are to contain only “reasonable and necessary” information. Other information that the contractor wishes to communicate to providers is to be communicated through an article.
J12 MAC LCD Final Listing
As of August 1, 2008, the fifty-seven (57) LCDs and the articles listed below (both LCD-related articles and NCD coding and other related articles) are effective for the following:
DC Part A and DCMA Part B
Maryland Part A and Maryland Part B
Pennsylvania Part A
Delaware Part B
These will become effective for other states when the respective locale cuts over to J12 MAC. Please see the J12 implementation schedule for details. Until each locale's cutover date, the current outgoing contractor LCDs remain in effect.
Click here for the Comment/Response Document.
Click here for the NCD Coding and other related articles.
Click here for Self-Administered Drug Exclusions.
Click here for the J12 MAC archive.
MAC Policy Number |
MAC Policies |
Related MAC Article |
| L27473 | Approved Drugs and Biologicals |
A47797 |
Blepharoplasty/Blepharoptosis |
N/A |
|
Blood Glucose Monitoring in a Skilled Nursing Facility (SNF) |
N/A | |
Botulinum Toxin Type A and B |
A47789 | |
Cancer Chemotherapeutic Agents |
N/A | |
Cardiovascular Stress Testing |
A47786 | |
Cataract Surgery |
N/A |
|
Chiropractic Services |
A47798 | |
Co-Management of Surgical Procedures |
A47790 | |
Complex Cataract Extraction |
N/A | |
Computed Tomographic Angiography of the Chest |
N/A | |
Consultations |
N/A | |
Coverage of Services and Procedures in Nursing Facilities |
N/A |
|
Routine Foot Care |
N/A |
|
Debridement of Mycotic Nails |
N/A |
|
Diagnostic Laryngoscopy |
N/A | |
Monitored Anesthesia Care (MAC) |
N/A | |
Electrocardiography |
N/A | |
End - Diastolic Pneumatic Compression Therapy |
N/A | |
Erythropoiesis Stimulating Agents (ESAs) |
A47817 | |
Evaluation and Management Services in a Nursing Facility |
N/A | |
Fluorescein and Indocyanine Green Angiography |
N/A |
|
Fundus Photography |
N/A |
|
Intraoperative Neurophysiological Testing |
N/A |
|
Luteinizing Hormone-Releasing Hormone (LHRH) Analogs |
N/A |
|
Magnetic Pelvic Floor Stimulation (MPFS) |
N/A |
|
Magnetic Resonance Imaging (MRI) of the Breast |
N/A |
|
Moh's Micrographic Surgery |
N/A |
|
Non-Invasive Cerebrovascular Arterial Studies |
A47800 | |
Non-Invasive Peripheral Venous Studies |
A47801 | |
Ophthalmic A and B Scans |
N/A |
|
Ophthalmic Biometry for Intraocular Lens (IOL) Power Calculation |
A47792 | |
Extended Ophthalmoscopy |
N/A | |
Parathormone (Parathyroid Hormone) |
N/A |
|
Paravertebral Facet Joint Nerve Block and Sacroiliac Joint Injection |
N/A |
|
Physical Medicine and Rehabilitation Services, PT and OT |
N/A | |
Psychiatric Therapeutic Procedures |
N/A | |
Radiation Therapy Services |
N/A | |
Radiologic Examination of the Chest (CXR) |
N/A |
|
Real-Time, Outpatient Cardiac Monitoring |
N/A |
|
Removal of Benign or Premalignant Skin Lesions |
N/A |
|
Removal of Impacted Cerumen |
N/A |
|
Scanning Computerized Ophthalmic Diagnostic Imaging |
N/A |
|
Sleep Disorders Testing |
N/A |
|
Speech-Language Pathology (SLP) Services: Communication Disorders |
N/A |
|
Surgical Treatment of Nails |
A47803 | |
Surveillance of Implantable Cardioverter-Defibrillator (ICD), Office, Internet or Non-Internet Based |
A47804 | |
Thermotherapies (Minimally Invasive Surgical Techniques [MISTs] for Benign Prostatic Hyperplasia (BPH)) |
N/A |
|
Transesophageal Echocardiography (TEE) |
A47805 | |
Transthoracic Echocardiography (TTE) |
A47806 | |
Speech-Language Pathology (SLP) Services: Dysphagia; Includes VitalStim® Therapy |
N/A |
|
Treatment of Varicose Veins of the Lower Extremities |
N/A |
|
Trigger Point Injections |
N/A |
|
Visual Fields |
N/A |
|
Wound Care |
A47793 | |
Acute Care: Inpatient, Observation, and Treatment Room Services |
A47796 | |
Human Skin Equivalents (HSE) - Use in the Treatment of Chronic Cutaneous Ulcer Wounds |
N/A |