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Novitas Solutions, Inc.: Medicare jurisdictions and Local Coverage Determinations

Novitas Solutions, Inc. administers Medicare fee-for-service claims in 12 states and territories through 26 contracts, and maintains 71 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
71
Contracts
26
04111, 04112, 04211, 04212, 04311, 04312, 04411, 04412, 04911, 07101, 07102, 07201, 07202, 07301, 07302, 12101, 12102, 12201, 12202, 12301, 12302, 12401, 12402, 12501, 12502, 12901
States and territories
12
AR CO DC DE LA MD MS NJ NM OK PA TX
Contractor site
www.novitas-solutions.com

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 Novitas Solutions, Inc.
ContractTypeStates
04111A and B MACCO
04112A and B MACCO
04211A and B MACNM
04212A and B MACNM
04311A and B MACOK
04312A and B MACOK
04411A and B MACTX
04412A and B MACTX
04911A and B MACCO NM OK TX
07101A and B MACAR
07102A and B MACAR
07201A and B MACLA
07202A and B MACLA
07301A and B MACMS
07302A and B MACMS
12101A and B MACDE
12102A and B MACDE
12201A and B MACDC
12202A and B MACDC
12301A and B MACMD
12302A and B MACMD
12401A and B MACNJ
12402A and B MACNJ
12501A and B MACPA
12502A and B MACPA
12901A and B MACDC DE MD NJ PA

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 Novitas Solutions, Inc.
LCDTitleEffective
L35010Trigger Point Injections2026-09-06
L40276Non-invasive Arterial Duplex Ultrasound of the Upper and Lower Extremities2026-05-17
L36920Epidural Steroid Injections for Pain Management2026-04-09
L38809Botulinum Toxins2025-11-09
L35396Biomarkers for Oncology2025-04-24
L39365Genetic Testing in Oncology: Specific Tests2025-04-24
L38712Transurethral Waterjet Ablation of the Prostate2025-04-06
L39879Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound2024-12-01
L39793Cervical Fusion2024-08-11
L34892Facet Joint Interventions for Pain Management2024-08-11

All active LCDs (71)

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 Novitas Solutions, Inc. cover?

Novitas Solutions, Inc. holds 26 Medicare contracts (04111 A and B MAC; 04112 A and B MAC; 04211 A and B MAC; 04212 A and B MAC; 04311 A and B MAC; 04312 A and B MAC; 04411 A and B MAC; 04412 A and B MAC; 04911 A and B MAC; 07101 A and B MAC; 07102 A and B MAC; 07201 A and B MAC; 07202 A and B MAC; 07301 A and B MAC; 07302 A and B MAC; 12101 A and B MAC; 12102 A and B MAC; 12201 A and B MAC; 12202 A and B MAC; 12301 A and B MAC; 12302 A and B MAC; 12401 A and B MAC; 12402 A and B MAC; 12501 A and B MAC; 12502 A and B MAC; 12901 A and B MAC) covering AR, CO, DC, DE, LA, MD, MS, NJ, NM, OK, PA, TX.

How many LCDs does Novitas Solutions, Inc. have?

71 Local Coverage Determinations are active in the current Medicare Coverage Database export for Novitas Solutions, Inc.. 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.