[2] In the absence of a NCD, an item or service is covered at the discretion of the Medicare contractors based on a local coverage determination (LCD).
External parties who may request an NCD are Medicare beneficiaries, manufacturers, providers, suppliers, medical professional associations, or health plans.
NCDs can also be internally generated by the Centers for Medicare and Medicaid Services (CMS) under multiple circumstances.
When an NCD does not exclude coverage for other diagnoses/conditions, contractors should allow individual consideration, unless the LCD supports automatic denial of some or all of those other diagnoses/conditions.
When national policy bases coverage on need assessment by the beneficiary's provider, LCDs should not include prerequisites.