The lookup in five steps
- Identify the jurisdiction. Institutional and professional claims go to the A/B MAC for the state where the service was rendered; durable medical equipment, prosthetics, orthotics and supplies go to one of the four DME MAC regions; home health and hospice claims go to the HHH contractor for the region. The table below maps states to A/B contractors, and each contractor hub lists its contract numbers so the jurisdiction on a remittance can be matched to the policy owner.
- Search the Medicare Coverage Database. The LCD and Article search accepts a keyword, a CPT or HCPCS code, a document ID or a state and contractor filter. Searching by code returns the Billing and Coding Articles that list it, and each article links to its parent LCD; searching by keyword returns the LCD titles directly. Retired and proposed documents are filtered out by default, so toggle them on when reconstructing a denial from last year.
- Read the LCD for the clinical rule. The determination states the covered indications, the limitations, the documentation the record must contain and the sources of evidence the contractor relied on. It does not list codes.
- Read the article for the codes. The companion Billing and Coding Article carries the ICD-10-CM codes that support medical necessity, grouped by the procedure codes they apply to, plus modifier rules, frequency limits and billing instructions. Contractors load the article, not the LCD, as the automated edit.
- Check the dates and status. Every document shows an original effective date, a revision effective date and, for retired policies, an end date. A claim is judged against the version in force on the date of service, and a revision that added or removed a diagnosis code explains most sudden changes in denial volume.
Which contractor writes the LCDs for each state
Each contractor hub lists every active LCD with its effective date and a link to the CMS record, the ten most recently revised policies, and the contract numbers that appear on remittances.
| Contractor | States and territories | Active LCDs | Most recent revision |
|---|---|---|---|
| CGS Administrators, LLC | AL AR CO DC DE FL GA IA IL IN KS KY LA MD MI MN MO MS MT NC ND NE NM OH OK PA PR SC SD TN TX UT VA VI WI WV WY | 204 | L40261 (2026-10-25) |
| First Coast Service Options, Inc. | FL PR VI | 79 | L33912 (2026-09-06) |
| Noridian Healthcare Solutions, LLC | AK AS AZ CA CNMI CT DC DE GU HI IA ID KS MA MD ME MO MT ND NE NF NH NJ NV NY OR PA RI SD SF UT VT WA WY | 174 | L40265 (2026-11-01) |
| Novitas Solutions, Inc. | AR CO DC DE LA MD MS NJ NM OK PA TX | 71 | L35010 (2026-09-06) |
| Palmetto GBA | AL AR FL GA IL IN KY LA MS NC NM OH OK SC TN TX VA WV | 190 | L40263 (2026-10-25) |
| Wellpoint Federal | AK AS AZ CA CNMI CT DN GU HI ID IL MA ME MI MN NH NJ NV NY OR PR QN RI UN VI VT WA WI | 89 | L33622 (2026-10-25) |
| Wisconsin Physicians Service Insurance Corporation | AK AL AR AZ CA CO CT DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MO MS MT NC ND NE NH NJ NM NV OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY | 113 | L40300 (2026-10-25) |
How to read an LCD once you have it
Local Coverage Determinations follow a fixed template, and the sections that matter for a claim are the coverage indications, limitations and medical necessity statement, the documentation requirements, and the summary of evidence. The indications describe the clinical picture the contractor accepts, often with thresholds such as a failed trial of conservative treatment, a laboratory value or a frequency per year; the limitations describe the situations the contractor will not pay for, which is where most denials originate. Documentation requirements say what the record must show at the time of the service, which the contractor can request later through a medical review or a Targeted Probe and Educate round. A proposed LCD is open for a 45-day comment period and must be posted for at least 45 days before it takes effect, and the contractor must respond to comments in a published response document, which is often the clearest explanation of why a criterion was written the way it was.
The LCD number is the handle that connects the policy to everything else. Final determinations carry an L followed by five digits, proposed ones a DL prefix, and the companion Billing and Coding Article an A followed by five digits; the number persists through revisions, so a remittance remark from a year ago still points at the same policy family even if the criteria have since changed. When the Medicare Coverage Database shows the policy as retired, look for the replacement in the same contractor's list, because contractors consolidate overlapping policies and the retired record names its successor.
From an LCD denial to an appeal
An LCD denial reaches the practice as reason code 50, not deemed a medical necessity, with remark code N115, which says the decision was based on a Local Coverage Determination. Open the policy named in the remark, compare the diagnosis on the claim with the article's covered list, and read the documentation requirements against the chart. If the record supports a covered indication that the claim failed to communicate, submit a corrected claim or a redetermination within 120 days of the remittance with the documentation attached; contractors overturn a large share of LCD denials at the first level when the note contains the element the policy asks for. If the service genuinely falls outside the policy, the beneficiary can be billed only when a valid Advance Beneficiary Notice was signed before the service, and the claim should have carried modifier GA to say so. Prior authorization and pre-service review exist for exactly the services that sit in an LCD's limitations section, which is where the drug code pages on this site list the coverage articles that mention each code before it is billed.
Frequently asked questions
What is a Local Coverage Determination?
An LCD is a decision by a Medicare Administrative Contractor on whether an item or service is reasonable and necessary under section 1862(a)(1)(A) of the Social Security Act, applied across the contractor's jurisdiction. It is written only where no National Coverage Determination controls, and it cannot conflict with one.
How do I look up an LCD by CPT or HCPCS code?
Open the Medicare Coverage Database, choose the LCD and Article search, enter the code and the state, and read the results in two parts: the LCD for the clinical criteria and the companion Billing and Coding Article for the CPT, HCPCS and ICD-10 codes. On this site each HCPCS drug code page lists the articles that mention the code, and each MAC hub lists the contractor's active LCDs.
What do the L and A numbers mean?
Final LCDs are numbered L followed by five digits, proposed LCDs DL followed by five digits, and Billing and Coding Articles A followed by five digits. The number stays with the policy across revisions, so a denial remark that names an L number always points at the same policy family.
Why does my LCD have no codes in it?
Since January 2019 contractors keep diagnosis and procedure codes out of the LCD itself and publish them in the attached Billing and Coding Article. The LCD states the clinical indications and documentation requirements; the article states which ICD-10-CM codes support medical necessity and which HCPCS or CPT codes the policy edits.
Which remark code tells me a denial was based on an LCD?
Claim adjustment reason code 50 paired with remark code N115, which states that the decision was based on a Local Coverage Determination and tells the biller to check the policy for the covered indications and documentation.
Sources
Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-02. Verify against the primary file before billing or contracting decisions.
- Medicare Coverage Database, current LCD exportVersion MCD release 2026-09-24 · effective 2026-09-20 · file lcd.csvSHA-256 2fcc4251b6ddd1eb…
Disclaimer
Contractor jurisdictions and LCD counts are reproduced from the CMS Medicare Coverage Database export as an operational reference. Verify coverage against the current LCD and article text on cms.gov before billing. Not legal, clinical or billing advice.