Skip to main content

Palmetto GBA: Medicare jurisdictions and Local Coverage Determinations

Palmetto GBA administers Medicare fee-for-service claims in 18 states and territories through 15 contracts, and maintains 190 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
190
Contracts
15
10111, 10112, 10211, 10212, 10311, 10312, 11004, 11201, 11202, 11301, 11302, 11401, 11402, 11501, 11502
States and territories
18
AL AR FL GA IL IN KY LA MS NC NM OH OK SC TN TX VA WV
Contractor site
www.palmettogba.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 Palmetto GBA
ContractTypeStates
10111A and B MACAL
10112A and B MACAL
10211A and B MACGA
10212A and B MACGA
10311A and B MACTN
10312A and B MACTN
11004A and B and HHH MACAL AR FL GA IL IN KY LA MS NC NM OH OK SC TN TX
11201A and B and HHH MACSC
11202A and B and HHH MACSC
11301A and B and HHH MACVA
11302A and B and HHH MACVA
11401A and B and HHH MACWV
11402A and B and HHH MACWV
11501A and B and HHH MACNC
11502A and B and HHH MACNC

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 Palmetto GBA
LCDTitleEffective
L40263Peripheral Nerve Injections and Procedures for Chronic Pain2026-10-25
L40238MolDX: Genetic Testing for Hereditary Thrombophilia2026-10-12
L40210MolDX: Non-Next Generation Sequencing Targeted Molecular Panel Tests for Targeted Therapy in Cancer2026-10-12
L40328Allergy Diagnostic Testing2026-09-27
L39237Erythropoiesis Stimulating Agents2026-09-17
L40058MolDX: Molecular Testing for Solid Organ Allograft Rejection2026-08-30
L38026Corneal Hysteresis2026-08-13
L40187MolDX: Biomarker Testing in Metabolic Dysfunction-Associated Steatotic Liver Disease and Metabolic Dysfunction-Associated Steatohepatitis2026-08-10
L39128Amniotic and Placental-Derived Product Injections and/or Applications for Musculoskeletal Indications, Non-Wound2026-07-16
L40205Irreversible Electroporation for Cancer2026-07-05

All active LCDs (190)

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 Palmetto GBA cover?

Palmetto GBA holds 15 Medicare contracts (10111 A and B MAC; 10112 A and B MAC; 10211 A and B MAC; 10212 A and B MAC; 10311 A and B MAC; 10312 A and B MAC; 11004 A and B and HHH MAC; 11201 A and B and HHH MAC; 11202 A and B and HHH MAC; 11301 A and B and HHH MAC; 11302 A and B and HHH MAC; 11401 A and B and HHH MAC; 11402 A and B and HHH MAC; 11501 A and B and HHH MAC; 11502 A and B and HHH MAC) covering AL, AR, FL, GA, IL, IN, KY, LA, MS, NC, NM, OH, OK, SC, TN, TX, VA, WV.

How many LCDs does Palmetto GBA have?

190 Local Coverage Determinations are active in the current Medicare Coverage Database export for Palmetto GBA. 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.