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DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services 7500 Security Boulevard Baltimore, Maryland 212441850MEDICARE ENROLLMENT & APPEALS GROUP DATE:December 22, 2015TO:Medicare
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Local coverage articles provide guidance on specific medical services or items that are covered under Medicare in a local jurisdiction.
Providers and suppliers who wish to submit claims for services or items that may be covered under Medicare in their specific locality are required to file local coverage articles.
To fill out a local coverage article, providers should follow the specific guidelines outlined by their local Medicare Administrative Contractor (MAC), ensuring all necessary information is included.
The purpose of a local coverage article is to clarify coverage decisions and guidelines for healthcare providers, helping to ensure that claims are processed correctly based on local policies.
Information that must be reported includes the service or item description, medical necessity criteria, coverage limitations, and any applicable coding guidelines.
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