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Understanding Local Coverage Determination Timelines

Noridian is providing education on understanding Local Coverage Determination (LCD) timelines relating to LCD development, reconsideration, revision, and review. There are four distinct stages involved in processing an LCD from draft to active status: 1. The comment period; 2. The comment review period, with development of responses; 3. The notice period; 4. The active period,(i.e., the LCD is in effect). Comment Period is a Minimum of 45 Days NAS considers all comments from the public, and the medical community. Comment Review Period This timeframe begins after the 45 day Comment Period ends. During this period the Contractor Medical Directors (CMD) review all comments, develop responses, update the LCD, and prepare for the Notice Period. Notice Period Once the LCD is amended in accordance with the responses to the comments, the LCD is posted to the CMS website in the Medicare Coverage Database (MCD) as a Final LCD, however; it is not yet Active. Providers do have 45 days from the date of posting notice to implement billing changes and educate staff before the LCD implementation. Active Period The actual LCD implementation date is the effective date and occurs on the 46th day from the first date of the Notice Period. Located in the body of the LCD under the, "Original Determination Effective Date," or "Revision Effective Date" depending on whether the LCD is new or revised. The MCD will notify contractors of each LCD that is affected by an update to a HCPCS code or ICD-9-CM code. Noridian shall review and approve and/or appropriately revise affected LCDs within 120 days of the date of notification. If there are major changes, Noridian shall revise the effective date, revision number and revision history.

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INDUSTRY NEWS TAGS: Noridian


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