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EXTENDED TO NOVEMBER 16, 2020990Form (Rev. January 2020)Return of Organization Exempt From Income Tax OMB No. 15450047 Do not enter social security numbers on this form as it may be made public. Open
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Local coverage determination is used by Medicare Administrative Contractors (MACs) to determine whether a particular service or item is covered under the Medicare program.
Healthcare providers and suppliers who want to seek Medicare coverage for a particular service or item are required to file local coverage determination.
Local coverage determination can be filled out by submitting the necessary information and documentation to the appropriate MAC.
The purpose of local coverage determination is to ensure that Medicare beneficiaries have access to medically necessary and appropriate services and items.
Information such as medical necessity, supporting documentation, and billing codes must be reported on local coverage determination.
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