Question

Local Care Determination (LCD)

You are a compliance coordinator. Part of your job is to assist the admission clerk in determining If Medicare will cover services ordered or if an advance beneficiary notice needs to be given. You are developing a table for the admission clerks to cross-reference when admitting patients.

To accomplish this, review the local care determination (LCD) for each procedure identified in Table 5-6 and use the table to explain the LCD. LCDs can be found online at http://www.cms.hhs.gov. you can also find a direct link to LCDs int eh web links section of the student companion website. Table 5-6 is also available on the website for your use.

If there are multiple LCDs, use the first one listed.

Table 5-6 LCD

LCD
Procedure	Does Medicare Cover?	Limitations, If Any	Last Date Reviewed	LCD ID
Blepharoplasty, eyelid surgery, and brow lift
Endoscopic treatment of GERD
Enteral nutrition
Flow cytometry
Lumbar epidural injections
Mohs micrographic surgery
Proton beam therapy
Removal of benign skin lesions
Trigger points, local injections
Wound care

Answer 1

1. Blepharoplasty,eyelid surgery and brow lift . Medicare does not typically cover cosmetic surgery such as eyelid surgery, but you may be in luck if the procedure is considered medically necessary by a doctor. .Medicare will only cover your surgery if you have: Physical signs of upper eyelid skin excess.

Last day reviewed - 10-1-2018

LCD ID - L34194

2. Endoscopic treatment of GERD - yes minimally endoscopic treatment of GERD is included in LCD .

Last date reviewed - 10/1/2018

LCD ID - 35080

3. Enteral nutrition - . Accordingly, to qualify for Medicare coverage, enteral nutritional therapy must be given via an enteral feeding tube. Medicare does not cover oral nutritional supplements.

Last date reviewed - 10/1/2018

LCD ID - 33783

4. Flow cytometry - yes it is covered by the Medicare.

Last date reviewed - 10/1/2015

LCD ID - L34651