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SCHEDULE 2 THE SERVICES A.Service SpecificationsMandatory headings 1 4: mandatory but detail for local determination and agreement Optional headings 57: optional to use, detail for local determination
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A new local coverage determination (LCD) is a policy issued by a Medicare Administrative Contractor (MAC) that outlines when specific medical services or items are covered and sets forth the requirements for documentation and medical necessity.
Providers, suppliers, and other stakeholders who wish to request changes or new coverage decisions must file a new local coverage determination.
Filling out a new local coverage determination typically involves submitting a request form through the MAC's online system along with supporting clinical data, evidence of medical necessity, and any relevant literature or studies.
The purpose of a new local coverage determination is to ensure that Medicare beneficiaries receive appropriate and necessary healthcare services while maintaining cost-effectiveness and compliance with federal regulations.
The information reported must include the specific service or item being requested for coverage, supporting clinical evidence, a rationale for coverage, expected patient outcomes, and any applicable coding information.
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