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Kidney Resources

A Local Coverage Determination (LCD), as established by Section 522 of the Benefits Improvement and Protection Act, is a decision by a fiscal intermediary or carrier whether to cover a particular service on an intermediary-wide or carrier-wide basis in accordance with Section 1862(a)(1)(A) of the Social Security Act (i.e., a determination as to whether the service is reasonable and necessary).

The following end stage renal disease LCD’s are listed by fiscal intermediary and are used as a guidelines for hospice providers to determine appropriateness for hospice services before a patient is admitted to hospice care and to document a patient’s continuing appropriateness for hospice services.  Remember – these are guidelines and not regulations.  A patient may not meet all indicators within the LCD, but still be extremely appropriate to receive hospice services.  Assessment of all the patient’s needs is extremely important.

CGS LCDs (Revision Effective Date:  For services performed on or after 07/02/2011)

NGS LCDs (Revision Effective Date:  For services performed on or after 04/01/2011)

Palmetto LCDs (Original Determination Effective Date: For services performed on or after 01/24/2011)

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