Part B Transition News: Palmetto Posts New Local Coverage Determinations, Physicians Urged to Review

Palmetto GBA’s medical directors have finalized and posted a revised set of Local Coverage Determinations (LCDs) for North Carolina and the other states in the Jurisdiction 11 Part B MAC.  Medicare physicians and staff should carefully review the posted LCDs, which provide new indications and limitations of Medicare coverage.  There will be 68 new or revised LCDs, while 66 LCDs currently in effect around the jurisdiction will be retired.

Palmetto’s contract does not allow the company to engage in a comment period or reconsideration process for the LCD changes prior to the May 28 Operational Date, when these policies go active and all pending and in-process Part B operations transfer from CIGNA Government Services to Palmetto.  However, Palmetto has agreed to revisit and reconsider any LCDs that prove problematic for patients and physicians after May 28.  Again, these policies will not take effect until May 28.

Access the list of proposed LCDs and review policy details by proceeding to Palmetto GBA’s website and clicking on “Future Effective Date.”  This will direct you to a CMS-hosted LCD directory.  NOTE:  You may notice that the directory is marked for Virginia and contains a March 19 effective date.  Please do not be confused.  The policies will be the same in North Carolina Part B and will take effect here on May 28.  We wanted to provide you with early-early notice by taking advantage of Virginia’s March Operational Date.  The NCMS has also posted a listing of the new LCDs in its Medicare Resource Center.

Physicians should review the list and relevant policies for changes, and contact the NCMS or Palmetto GBA with concerns.


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