What is the difference between an LCD and an NCD?

An NCD (National Coverage Determination) applies to all Medicare contractors nationwide. It sets the floor for coverage — if the NCD says a service is covered, no MAC can deny it based on a local policy. An LCD (Local Coverage Determination) is issued by a specific MAC and applies only to providers in that jurisdiction. LCDs can add documentation requirements or coverage limitations beyond the NCD, but they cannot override an NCD's coverage determination.

How do I find which MAC covers my region?

The Coverage Database allows you to filter by jurisdiction. There are 12 MAC jurisdictions covering different geographic regions — for example, Jurisdiction A covers New England and parts of the Mid-Atlantic, Jurisdiction B covers Illinois, Michigan, Minnesota, and others. If you do not know your jurisdiction, search by CPT code first, then look at the LCD results — each LCD shows the MAC and jurisdiction it belongs to.

Can I appeal a procedure that is not covered by an LCD?

An LCD that says a service is 'non-covered' means Medicare will not pay for it in that jurisdiction under any circumstances unless the policy explicitly allows individual consideration. You can still submit a claim with a GA modifier (waiver of liability) or a GZ modifier (expected denial), and you can appeal a non-coverage determination, but the appeal must argue that the specific clinical circumstances of the case meet an exception. These appeals have a lower success rate than documentation-focused appeals.

What does it mean when a policy is marked as 'Draft'?

A draft policy is a proposed LCD that has been published for public comment but has not been finalized. It has no legal effect — you are not required to follow it yet. During the comment period, providers and professional organizations can submit feedback. Once the comment period closes, the MAC reviews the feedback and publishes a final policy with an effective date.

What is an LCD reopening?

A reopening is a revision to an existing LCD outside the normal annual update cycle. Reopenings can be triggered by new clinical evidence, changes in technology, or corrections to the existing policy. When an LCD is reopened, the MAC publishes the proposed changes, accepts comments, and then issues a final revised policy. The database shows both the original and revised versions.

How often are coverage policies updated?

NCDs are updated as needed through a formal CMS process. LCDs are typically reviewed annually, but can be reopened at any time. New LCDs are published throughout the year as MACs identify services that need local coverage guidance. The Coverage Database shows the most current published policy from CMS.

Guide · 8 min read

How to Use the
Medicare Coverage Database

Find LCDs, NCDs, and coverage policies in minutes. Real advice on jurisdiction mapping, policy types, and what actually matters when verifying Medicare coverage.

Search the Coverage Database

The Short Version

The Medicare Coverage Database is a real-time interface to the CMS Medicare Coverage Database. Search by CPT code, ICD-10 code, or keyword to find LCDs, NCDs, and code-to-coverage mappings. View full policy details — indications, limitations, documentation requirements, and effective dates.

It is the same data that Medicare contractors and MACs use to make coverage decisions. Every LCD and NCD in the CMS system is accessible from a single search bar. No more digging through contractor websites or PDF archives.

8K+

Active LCDs

200+

NCDs

MAC Jurisdictions

100%

Free. No Account.

LCD vs NCD: What Is the Difference?

I once worked with a practice that lost $30,000 in a RAC recoupment because they assumed an LCD from a neighboring MAC did not apply to them. It did not — but they also failed to check whether their own MAC had a similar LCD. The auditor found that their documentation did not meet the requirements of their own jurisdiction's LCD, which was nearly identical to the one they had ignored.

NCDs are published by CMS and apply everywhere. If CMS says cardiac rehabilitation is covered for post-CABG patients under NCD 20.10, every MAC in every state must follow that determination. LCDs are published by individual MACs and apply only to providers in that MAC's jurisdiction. An LCD can add documentation requirements, specify covered diagnosis codes, or limit the frequency of a service — but it cannot reverse an NCD's coverage decision.

The practical difference matters more than the legal one. When you search the Coverage Database, you need to know whether the policy you are reading is an NCD (applies to you no matter where you are) or an LCD (applies only if you are in that MAC's jurisdiction). The tool labels each result clearly, but it is your responsibility to filter by your jurisdiction before relying on an LCD.

How to Use the Coverage Database

Search by CPT or ICD-10 Code

Search by entering a CPT procedure code, an ICD-10 diagnosis code, or a keyword like 'cardiac' or 'MRI.' The tool queries the CMS Medicare Coverage Database in real time and returns matching LCDs and NCDs instantly.

Browse LCDs, NCDs & Code Mappings

Results are organized by type — LCDs (local policies specific to a Medicare contractor jurisdiction), NCDs (national policies that apply everywhere), and code-to-coverage mappings showing which CPT/ICD-10 codes are linked to which policies.

View Full Policy Details

Click any policy to see the complete details — indications and limitations of coverage, documentation requirements, CPT/HCPCS coding guidelines, ICD-10 diagnosis codes that support medical necessity, and the effective dates of the policy.

Common Use Cases

Verifying Coverage Before Submitting

A provider is about to submit a claim for a cardiac PET scan (CPT 78431). Before filing, you search the Coverage Database to verify that Medicare covers this procedure for the patient's diagnosis of coronary artery disease. The database returns an NCD (220.6) confirming coverage for myocardial perfusion imaging, and an LCD from the local MAC with specific documentation requirements — the patient must have a documented inability to exercise or an inconclusive stress test before PET is covered. The procedure is covered, but you need to add the stress test results to the chart before submitting.

Finding Documentation Requirements in an LCD

A new MAC takes over jurisdiction for your region and publishes an updated LCD for lumbar spine MRI. You need to know what documentation is required before the first claim goes out. The database shows the full LCD — it requires specific physical exam findings (motor, sensory, reflex), documentation of 6 weeks of conservative therapy, and the exact ICD-10 codes that support medical necessity for each spinal region. The LCD also lists codes that are automatically covered vs those that require additional documentation.

Checking Draft vs Final Policy Status

You hear through the industry that a MAC is proposing a new LCD that would restrict coverage for a commonly billed procedure. You find the policy in the database and see it is marked as 'Draft' — not yet finalized. The draft policy shows the proposed effective date, the comment period window, and the proposed limitations. This gives you time to submit comments, prepare your practice for the changes, and review whether the final policy differs from the draft when it is published.

Tips from the Trenches

Three things I wish every coder knew about Medicare coverage policies.

Know Your Jurisdiction — Every MAC Has Different LCDs

Medicare Administrative Contractors (MACs) are divided into 12 jurisdictions, and each one publishes its own LCDs. An LCD from Jurisdiction B (Novitas) does not apply in Jurisdiction E (WPS). I have seen practices copy documentation requirements from the wrong MAC's LCD and fail an audit. Before you follow any LCD, verify that it belongs to your jurisdiction. The Coverage Database filters by jurisdiction — always set this filter before you start searching.

Draft vs Final — They Are Not the Same

A draft LCD is a proposed policy that is open for public comment. It has no legal effect until it is finalized. A final LCD is binding — you must follow its documentation requirements to be paid. I have seen practices change their workflows based on a draft policy, only to have the final version look completely different. Use draft policies to prepare, but do not change your billing practices until the final policy is published with its effective date.

Reopenings Can Change Coverage Mid-Year

An LCD reopening is when a MAC revises an existing policy outside the normal annual update cycle. Reopenings can be triggered by new clinical evidence, a change in the NCD, or a Medicare contractor advisory committee recommendation. If a procedure you bill has an LCD, I recommend checking the Coverage Database every quarter — even if you think the policy has not changed. I have seen a reopening add a new documentation requirement with only 30 days' notice.

Frequently Asked Questions

Questions I hear from coders using the Coverage Database for the first time.

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