Reimbursement
Medicare Administrative Contractor(MAC)
In one line
Private contractors that process Medicare Part A/B and DME claims and issue Local Coverage Determinations within their jurisdictions.
Definition
Medicare Administrative Contractors (MACs) are private companies CMS contracts with under the Medicare Modernization Act of 2003 to process Medicare fee-for-service claims, enroll providers, conduct medical review, and issue Local Coverage Determinations (LCDs). The country is divided into A/B MAC jurisdictions and four DME MAC jurisdictions. As of 2025 the principal A/B MACs include Noridian, Palmetto, Novitas, NGS, CGS, First Coast, and WPS.
Why it matters
Because each MAC issues its own LCDs, the same device can be covered in one jurisdiction and not another — a structural reality MedTech market-access teams must plan around. MolDX (run by Palmetto) is the most influential MAC sub-program for molecular diagnostics.
Common pitfalls
- •Assuming a national LCD where only jurisdictional LCDs exist.
- •Engaging only one MAC when a multi-MAC strategy is needed for national coverage.
Sources
- CMS — Medicare Administrative Contractors · CMS
- 42 USC 1395kk-1 — Medicare Administrative Contractors · Cornell LII
- AdvaMed - Payment & Coverage · AdvaMed