All terms
Medicare Administrative Contractor
Private contractors that process Medicare Part A/B and DME claims and issue Local Coverage Determinations within their jurisdictions.
Reviewed by Christian Espinosa, Founder, Blue Goat CyberLast reviewed May 9, 2026
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. What the regulation says
Statutory basis: Section 911 of the MMA, codified at 42 USC 1395kk-1. LCD process: Chapter 13 of the Medicare Program Integrity Manual.
What this means in practice
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.
Primary references
3 sourcesLink health: 3 verified· last checked 2026-05-09
CMS·1Cornell LII·1AdvaMed·1
- 1
CMS — Medicare Administrative ContractorsVerifiedCMScms.gov
- 2
42 USC 1395kk-1 — Medicare Administrative ContractorsVerifiedCornell LIIlaw.cornell.edu
- 3
AdvaMed - Payment & CoverageVerifiedAdvaMedadvamed.org
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