Part B Insider (Multispecialty) Coding Alert

Question: Our local MAC has a policy stating that only physicians can perform a particular service, but the national coverage decision for that same service says that non-physician practitioners can perform it as well. Do we follow the local coverage decision or the national one?

Answer: You should follow the local coverage decision (LCD), CMS reps advised during a Jan. 29 Open Door Forum. "National policies would represent policy in the absence of a local coverage decision," the CMS rep said. "If the local contractor sends out a more restrictive policy, that would be their prerogative."