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Wellpoint Federal: Medicare jurisdictions and Local Coverage Determinations

Wellpoint Federal administers Medicare fee-for-service claims in 28 states and territories through 24 contracts, and maintains 89 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
89
Contracts
24
06004, 06101, 06102, 06201, 06202, 06301, 06302, 13101, 13102, 13201, 13202, 13282, 13292, 14014, 14111, 14112, 14211, 14212, 14311, 14312, 14411, 14412, 14511, 14512
States and territories
28
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
Contractor site
www.ngsmedicare.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 Wellpoint Federal
ContractTypeStates
06004HHH MACAK AS AZ CA CNMI GU HI ID MI MN NJ NV NY OR PR VI WA WI
06101MAC - Part AIL
06102MAC - Part BIL
06201MAC - Part AMN
06202MAC - Part BMN
06301MAC - Part AWI
06302MAC - Part BWI
13101A and B and HHH MACCT
13102A and B and HHH MACCT
13201A and B and HHH MACNY
13202A and B and HHH MACDN
13282A and B and HHH MACUN
13292A and B and HHH MACQN
14014A and B and HHH MACCT MA ME NH RI VT
14111A and B and HHH MACME
14112A and B and HHH MACME
14211A and B and HHH MACMA
14212A and B and HHH MACMA
14311A and B and HHH MACNH
14312A and B and HHH MACNH
14411A and B and HHH MACRI
14412A and B and HHH MACRI
14511A and B and HHH MACVT
14512A and B and HHH MACVT

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 Wellpoint Federal
LCDTitleEffective
L33622Pain Management - Injection of tendon sheaths, ligaments, bursa, and ganglion cysts2026-10-25
L40267Peripheral Nerve Injections and Procedures for Chronic Pain2026-10-25
L40330Allergy Diagnostic Testing2026-09-27
L33398Transcranial Magnetic Stimulation2026-08-09
L40334Erythropoiesis Stimulating Agents2026-07-15
L35000Molecular Pathology Procedures2026-07-15
L40302Thermal Destruction of the Intraosseous Basivertebral Nerve (BVN) for Vertebrogenic Lower Back Pain2026-07-15
L33394Drugs and Biologicals, Coverage of, for Label and Off-Label Uses2026-07-13
L37810Genomic Sequence Analysis Panels in the Treatment of Solid Organ Neoplasms2026-05-15
L39036Epidural Steroid Injections for Pain Management2026-05-07

All active LCDs (89)

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 Wellpoint Federal cover?

Wellpoint Federal holds 24 Medicare contracts (06004 HHH MAC; 06101 MAC - Part A; 06102 MAC - Part B; 06201 MAC - Part A; 06202 MAC - Part B; 06301 MAC - Part A; 06302 MAC - Part B; 13101 A and B and HHH MAC; 13102 A and B and HHH MAC; 13201 A and B and HHH MAC; 13202 A and B and HHH MAC; 13282 A and B and HHH MAC; 13292 A and B and HHH MAC; 14014 A and B and HHH MAC; 14111 A and B and HHH MAC; 14112 A and B and HHH MAC; 14211 A and B and HHH MAC; 14212 A and B and HHH MAC; 14311 A and B and HHH MAC; 14312 A and B and HHH MAC; 14411 A and B and HHH MAC; 14412 A and B and HHH MAC; 14511 A and B and HHH MAC; 14512 A and B and HHH MAC) covering 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.

How many LCDs does Wellpoint Federal have?

89 Local Coverage Determinations are active in the current Medicare Coverage Database export for Wellpoint Federal. 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.