Final answer:
If an NCD (National Coverage Determination) doesn't exist for a particular item, it's up to the local Medicare Administrative Contractor (MAC) to determine coverage. When there is no NCD for a Medicare item, the local Medicare Administrative Contractor (MAC) has the authority to determine whether the item will be covered, creating a Local Coverage Determination (LCD) for their region.
Step-by-step explanation:
In the United States, the Centers for Medicare & Medicaid Services (CMS) establishes national coverage policies through NCDs which specify whether particular medical items, services, treatment procedures, or technologies are covered by Medicare.
However, in cases where an NCD does not provide guidance, it is within the discretion of the local MACs to develop a Local Coverage Determination (LCD). These LCDs are determinations made by a MAC regarding whether or not a particular service or item is reasonable and necessary under Medicare law and are specific to their geographic jurisdiction. Since these entities operate in specific regions, the coverage decisions may vary across different areas based on variations in local practice patterns and availability of medical services.
The discretion awarded to MACs in these situations underscores the importance of locoregional policies and practices in the determination of Medicare coverage. Providers often must be aware of both NCDs and LCDs to ensure that their services are in line with Medicare coverage criteria to secure reimbursement.