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DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services 7500 Security Boulevard Baltimore, Maryland 212441850MEDICARE ENROLLMENT & APPEALS GROUP DATE:August 25, 2020TO:All Medicare
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A local coverage article is used to provide specific guidance regarding the coverage of medical services and procedures for a defined geographical area, often detailing conditions for reimbursement.
Healthcare providers, including hospitals and clinics, are typically required to file local coverage articles to ensure they meet the specific requirements for reimbursement in their area.
To fill out a local coverage article, providers should carefully follow the format and guidelines provided by the payer, ensuring all required information about the services rendered is accurately completed.
The purpose of a local coverage article is to outline the specific medical necessities, criteria for services, and reimbursement policies that are applicable to a local jurisdiction.
Information that must be reported includes details about the procedure or service, patient demographics, diagnosis codes, and any relevant documentation to support the coverage claim.
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