All terms
ReimbursementHospital Buyer & Reimbursement
LCD and NCD
Local and National Coverage Determinations from Medicare.
Reviewed by Christian Espinosa, Founder, Blue Goat CyberLast reviewed May 5, 2026
Definition
A National Coverage Determination (NCD) is a Medicare-wide policy on whether and under what conditions an item or service is covered. A Local Coverage Determination (LCD) is issued by a Medicare Administrative Contractor (MAC) for its jurisdiction. What the regulation says
The Centers for Medicare & Medicaid Services (CMS) establishes National Coverage Determinations (NCDs) to specify the conditions under which a particular medical item or service is covered nationally under Medicare. Local Coverage Determinations (LCDs) are developed by Medicare Administrative Contractors (MACs) to define coverage within their specific geographic jurisdictions, often preceding or complementing NCDs.What this means in practice
Coverage typically begins as LCD policy via one or more MACs; pivotal NCDs (e.g., TAVR, TCAR, TMVR) define the national clinical-evidence and facility/operator standards.Examples
- A MedTech manufacturer developing a new diagnostic imaging device must review existing NCDs and relevant LCDs to understand the evidence required for Medicare coverage and reimbursement.
- A quality assurance team ensures that product labeling and marketing materials accurately reflect the limitations and conditions of coverage specified in applicable NCDs and LCDs.
- During clinical trial design, a regulatory professional considers the data requirements outlined in potential NCDs or LCDs to ensure the study generates sufficient evidence for future reimbursement.
Common pitfalls
- •Misinterpreting an LCD as a national policy can lead to denied claims in other jurisdictions.
- •Failing to consider both NCDs and relevant LCDs when determining coverage for a medical device or service can result in incomplete reimbursement strategies.
- •Assuming that an absence of an NCD means automatic coverage can lead to significant financial losses if an LCD also denies coverage.
- •Not understanding the specific evidence requirements outlined in an NCD or LCD can lead to insufficient clinical trial design or data collection activities.
Frequently asked questions
NCDs and LCDs directly influence market access and reimbursement for MedTech products. Manufacturers must understand these policies to ensure their devices meet coverage criteria and are eligible for payment by Medicare.
Related terms
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New Technology Add-On Payment(NTAP)
Supplemental Medicare payment for inpatient use of qualifying new technologies.
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Market Segments
Molecular Diagnostics
IVDs that detect nucleic acids - DNA or RNA - to diagnose disease.
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Medicare Administrative Contractor(MAC)
Private contractors that process Medicare Part A/B and DME claims and issue Local Coverage Determinations within their jurisdictions.
Reimbursement & Market Access · adjacent
Reimbursement
National and Local Coverage Determinations(NCD / LCD)
Medicare coverage policies issued nationally (NCD) or by individual MAC contractors (LCD).
Reimbursement & Market Access · adjacent
Reimbursement
Budget Impact Model(BIM)
Financial model that estimates the total cost consequences of adopting a new technology to a payer's budget over a defined horizon.
Reimbursement & Market Access
Reimbursement
CPT Codes(CPT)
AMA-maintained codes that describe medical procedures and services.
Reimbursement & Market Access
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Primary references
2 sourcesLink health: 2 verified· last checked 2026-06-20
AdvaMed·1AMA·1
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