US · guidance
CMS Pub. 100-04, ch. 17, § 100.3
Application of Local Medical Review Policies
A/B MACs (B) and/or Program Safeguard Contractors shall apply all Local Coverage
Determination (LCD) policies and National Coverage Determination (NCD) policies to
the administration and no-pay drug code lines on the CAP claims.
Should it be determined that a drug administration or drug code service line does not
meet the requirements of the LCD, the A/B MAC (B) shall follow current processes to
determine how to adjudicate the related services.
If appropriate, the A/B MACs (B) shall include messages on the MSN and RA to indicate
which LCD was applied.
The A/B MACs (B) shall also apply all regular edits to the administration and no-pay
drug lines and send appropriate denial messages.
History
(Rev. 866, Issued: 02-17-06, Effective: 07-01-06, Implementation: 07-03-06)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
18c1c31cf54aec4f279c57e390e36d1fff9e56c142854ab83ebae904c7955bde
The link goes to the issuing authority’s own document — the one we read to produce this record. Where a source publishes whole titles rather than sections, your browser may need a moment to jump to the provision.
Unofficial copy of government-published law, reproduced from official sources with full provenance. Not an official publication; verify against official sources before relying on it in a filing. Records in the 'guidance' corpus, and only that corpus, are sub-regulatory (interpretive guidelines, survey procedures) and are not binding law. Validity bounds follow each jurisdiction's declared temporalBasis.