Medicare coverage is limited to items and services that are reasonable and necessary for the diagnosis or treatment of an illness or injury (and within the scope of a Medicare benefit category). National coverage determinations (NCDs) are made through an evidence-based process, with opportunities for public participation. In some cases, CMS ’own research is supplemented by an outside technology assessment and/or consultation with the Medicare Evidence Development &Coverage Advisory Committee (MEDCAC) . In the absence of a national coverage policy, an item or service may be covered at the discretion of the Medicare contractors based on a local coverage determination (LCD).
Last updated Nov 13, 2023