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How to find the Medicare coverage policy that applies to you.

How to find the Medicare coverage policy that applies to you.

This article teaches you how to locate either a Local Coverage Determination (LCD) or coverage article on hyperbaric oxygen therapy. Centers for Medicare and Medicaid Services (CMS) has a Medicare Coverage Database where you can search for LCDs and coverage articles from your Medicare Administrative Contractor (MAC). The website for this database is: http://www.cms.gov/medicare-coverage-database/. The webpage should look like the image below.

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At the top of this screen, choose the tab labeled “Advanced Search”.

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Under “Search by Document Type”, select “Local Coverage Documents”. Then select “All Local Coverage”. Then select your State. For this example, “Alabama” was chosen.

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Scroll the window down, select “Keyword(s)”, and type in a search word. For this example, the word “hyperbaric” is used. If you know the CPT/HCPCS code of the procedure, you can alternatively select “CPT/HCPCS” and enter the code.

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Select “Search by Type” at the bottom of the window. A list of documents meeting your search criteria will appear. In the example below, the only document found was a coverage article titled “NCD – Hyperbaric Oxygen Therapy (HBO)” (A48900).

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To read the article, select the plus sign on the left. It will reveal 2 copies of the same article. The documents are identical, but the MAC has 2 different contractor numbers so the document is listed under each of the 2 contractor numbers.

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Select either of the 2 Article ID numbers on the left to read the document. When you select the number, a screen titled “License Agreements” will appear. Scroll the window to the bottom and select “Accept”.

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The LCD should be open for you to read, print, or convert to a PDF file.

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As of 2019, only 2 MACs have a published LCD for Hyperbaric Oxygen Therapy (Novitas and First Coast Service Options). For the other MACs, the default policy is the National Coverage Determination for Hyperbaric Oxygen Therapy (NCD 20.29). A few of the MACs have additional information, such as documentation requirements or a documentation checklist for hyperbaric oxygen therapy. These documents will not appear on the search described above. You must go to the MAC company website in order to find these. It is a good idea to search the MAC company website for any additional information that might be useful.

Below is a map of the MAC jurisdictions, identifying the company (e.g. Noridian, WPS, NGS) by State. Each MAC jurisdiction is labeled with a 2 character abbreviation, “J” for jurisdiction followed by a unique number or letter. If you do an internet search for the company name followed by “medicare”, you should find the company website (e.g. “Noridian medicare”, “WPS medicare”, “NGS medicare”).

Author:
Robert B. Sheffield, BA, CHT
Director of Education
International ATMO, Inc.

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