US · guidance
CMS Pub. 100-16, ch. 4, § 90.4.1
MAC with Exclusive Jurisdiction over a Medicare Item or
Service
(Rev. 120, Issued: 01-16-15, Effective: 01-01-15, Implementation: 01-01-15)
In some instances, one Medicare A/B MAC processes all of the claims for a particular
Medicare-covered item or service for all Medicare beneficiaries around the country. This
generally occurs when there is only one provider of a particular item or service (for
example, certain pathology and lab tests furnished by independent laboratories). In this
situation, MA plans must follow the coverage policy reflected in an LCD issued by the
A/B MAC that enrolled the provider and processes all of the Medicare claims for that
item or service.
History
(Rev. 120, Issued: 01-16-15, Effective: 01-01-15, Implementation: 01-01-15)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
58ceb198ebf745c5a590b38c49f76c025231e8e3eb5881aaaaa2664875952afd
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