Medicare Administrative Contractor
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.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.- •Assuming a national LCD where only jurisdictional LCDs exist.
- •Engaging only one MAC when a multi-MAC strategy is needed for national coverage.
Related terms
Shared paths + categoryLocal and National Coverage Determinations from Medicare.
Medicare coverage policies issued nationally (NCD) or by individual MAC contractors (LCD).
Medicare benefit category covering durable medical equipment, prosthetics, orthotics, and supplies, billed under HCPCS Level II codes through DME MACs.
Supplemental Medicare payment for inpatient use of qualifying new technologies.
Financial model that estimates the total cost consequences of adopting a new technology to a payer's budget over a defined horizon.
AMA-maintained codes that describe medical procedures and services.
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Primary references
3 sources- 1CMS, Medicare Administrative ContractorsVerifiedCMScms.gov
- 242 USC 1395kk-1, Medicare Administrative ContractorsVerifiedCornell LIIlaw.cornell.edu
- 3AdvaMed - Payment & CoverageVerifiedAdvaMedadvamed.org
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