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Outpatient Facility Coding Alert

Reader Question:

Know How to Handle LCD Non-Covered Dxs

Question: Does Medicare restrict coverage to only the diagnoses listed under the code’s Local Coverage Determination (LCD)? If so, are you able to appeal in order to argue medical necessity with a non-covered diagnosis? California Subscriber Answer: If you know you are submitting a claim with a diagnosis code that is not covered based on the CPT® code’s LCD, you [...]