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CGS Administrators, LLC: Medicare jurisdictions and Local Coverage Determinations

CGS Administrators, LLC administers Medicare fee-for-service claims in 37 states and territories through 7 contracts, and maintains 204 active Local Coverage Determinations in the current Medicare Coverage Database export. Each LCD below applies only inside this contractor's jurisdiction; the same service can be covered under different criteria by the neighbouring MAC.

Reviewed by QuickIntell RCM Editorial Team · Last reviewed

Data effective

Key facts

Active LCDs
204
Contracts
7
15004, 15101, 15102, 15201, 15202, 17013, 18003
States and territories
37
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
Contractor site
www.cgsmedicare.com/jc

Jurisdictions

Contract numbers identify the jurisdiction on remittances and in the Medicare Coverage Database; A and B MAC contracts cover both institutional and professional claims, while DME and HHH contracts are national or regional specialty jurisdictions.

Medicare contracts held by CGS Administrators, LLC
ContractTypeStates
15004HHH MACCO DC DE IA KS MD MO MT ND NE PA SD UT VA WV WY
15101MAC - Part AKY
15102MAC - Part BKY
15201MAC - Part AOH
15202MAC - Part BOH
17013DME MACIL IN KY MI MN OH WI
18003DME MACAL AR CO FL GA LA MS NC NM OK PR SC TN TX VA VI WV

Most recently effective LCDs

Revision effective dates signal where this contractor has tightened or loosened criteria; the ten newest are listed first, with the full list below.

Ten most recently effective LCDs from CGS Administrators, LLC
LCDTitleEffective
L40261Peripheral Nerve Injections and Procedures for Chronic Pain2026-10-25
L40259MolDX: Genetic Testing for Hereditary Thrombophilia2026-10-12
L40226MolDX: Non-Next Generation Sequencing Targeted Molecular Panel Tests for Targeted Therapy in Cancer2026-10-12
L40326Allergy Diagnostic Testing2026-10-04
L34356Erythropoiesis Stimulating Agents (ESA)2026-10-04
L35442MolDX: NRAS Genetic Testing2026-09-03
L38771Non-Invasive Fractional Flow Reserve (FFR) for Ischemic Heart Disease2026-09-03
L34393Ocular Photography - External2026-09-03
L34540Stretta Procedure2026-09-03
L34087Surveillance of Implantable or Wearable Cardioverter Defibrillators (ICDs): Office, Hospital, Web, or Non-Web Based2026-09-03

All active LCDs (204)

How to use this contractor's policies

A Local Coverage Determination applies only to claims processed by the contractor that wrote it, so the first question is which jurisdiction the rendering location falls in; the contracts table above answers that for institutional and professional claims, and durable medical equipment follows the DME MAC region instead. Each LCD states the covered indications, the documentation the record must contain and, through its companion Billing and Coding Article, the ICD-10 codes that support medical necessity and the HCPCS codes the policy edits. When a claim denies with CARC 50 and remark N115, the remark names the LCD; open it from the list above, compare the diagnosis on the claim with the article's covered list, and build the appeal on the documentation requirements rather than on the policy itself. Where this contractor has no LCD for a service and no National Coverage Determination exists, coverage is decided claim by claim under the reasonable-and-necessary standard, which is where prior authorization and pre-service review earn their keep.

Frequently asked questions

Which states does CGS Administrators, LLC cover?

CGS Administrators, LLC holds 7 Medicare contracts (15004 HHH MAC; 15101 MAC - Part A; 15102 MAC - Part B; 15201 MAC - Part A; 15202 MAC - Part B; 17013 DME MAC; 18003 DME MAC) covering 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.

How many LCDs does CGS Administrators, LLC have?

204 Local Coverage Determinations are active in the current Medicare Coverage Database export for CGS Administrators, LLC. Each LCD applies only in that contractor's jurisdiction, so the same service can be covered differently in a neighbouring state.

What is the difference between an LCD and an NCD?

A National Coverage Determination is set by CMS and binds every contractor. A Local Coverage Determination is written by one Medicare Administrative Contractor for its jurisdiction and cannot conflict with an NCD; where no NCD exists, the LCD is the controlling policy.

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.

Disclaimer

Contractor jurisdictions and LCD lists are reproduced from the CMS Medicare Coverage Database export as an operational reference. Verify coverage against the current LCD text on cms.gov or the contractor site before billing. Not legal, clinical or billing advice.