Resources

Click here to search for National and Local Coverage Determinations directly from the Medicare Coverage Database.

*The user must search by keyword(s), billing code or document ID to find coverage criteria. Please note that this site does list DMEPOS.  DMEPOS coverage criteria are established by Medicare's DMEPOS adjudication entities (per Jurisdiction) and noted in this Resources section. 

Learn about the applicability of "capped rental" for DME, oxygen equipment, orthotics and prosthetic devices. 

Capped Rental

(MLN Matters® Number: MM5461) 

Learn about the applicability of “reasonable useful lifetime” rules for DME, oxygen equipment, orthotics, prosthetic devices (there are exceptions).

CFR (eCFR.gov) §414.210 General Payment Rules

Reasonable Use Lifetime (RUL) for Oxygen

(MLN Matters® Number: MM7213) 

Noridian HealthCare Solutions is Medicare's contracted DMEPOS adjudication entity for Jurisdiction D (Am. Samoa, Guam, N. Mariana Is., AK, AZ, CA, HI, ID, IA, KS, MO, MT, NE, NV, ND, OR, SD, UT, WA, WY)

Click here to access a list of coverage criteria and external links to Local Coverage Determinations (LCDs) that apply to Jurisdiction D and identifies which State has adopted the criteria; and external links to National Coverage Determinations (NCDs) that are applicable to all States.

Celerian Group Company is Medicare's contracted DMEPOS adjudication company for Jurisdiction C (AL, AR, CO, FL, GA, LA, MS, NM, NC, OK, PR, SC, TN, TX, VI, VA and WV)

Click here to access a list of Local Coverage Determinations (LCDs) that apply to States in Jurisdiction C and external links to CMS LCD Database.

Celerian Group Company is Medicare's contracted DMEPOS adjudication company for Jurisdiction B (IL, IN, KY, MI, MN, OH, and WI)

Click here to access a list of Local Coverage Determinations (LCDs) that apply to States in Jurisdiction C and external links to CMS LCD Database.

Noridian HealthCare Solutions is Medicare's contracted DMEPOS adjudication entity for Jurisdiction A (CT, DE, MA, ME, MD, NH, NJ, NY, PA, RI, VT,
Washington D.C.)

Click here to access a list of coverage criteria and external links to Local Coverage Determinations (LCDs) that apply to Jurisdiction A and identifies which State has adopted the criteria; and external links to National Coverage Determinations (NCDs) that are applicable to all States.

Click here to learn about Hospital Acquired Conditions (HAC) that are reportable to and generally not payable by Medicare.