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Medicare Local Coverage Program

The LCD Process and CAC Representatives 

The CAP and its pathologist Contractor Advisory Committee (CAC) representatives advocate for fair reimbursement policies at the local Medicare level. By reviewing and commenting on pathology-related Local Coverage Determinations (LCDs) and policy changes before they are implemented, the CAP helps ensure that all pathologists are appropriately reimbursed for medically reasonable and necessary services provided to Medicare patients.

What is a Contractor Advisory Committee? Learn more by reading FAQs about CACs.

The CAP is grateful for the time and effort pathology CAC representatives spend participating in this important process. Being a CAC representative is a service to fellow pathologists, physicians, and patients. To assist representatives, the CAP has implemented a program to help pathologists identify, review, and write comments on draft LCDs.

Interested in becoming a CAC representative? Do you know who the representative is for your region? Email: nwilson@cap.org.

For more information on Medicare's local coverage process and the role of CAC representatives, refer to the Local Medicare Payment and CAP Coverage Program.

Medicare LCD Reform

The CMS announced in October 2018 the revision of Chapter 13 of Medicare’s Program Integrity Manual, which addresses LCDs. The revisions, the first changes to the manual since 2015, are in response to legislative requirements and comments from stakeholders, like the CAP. Around the same time, significant efforts were underway to gain passage of the Local Coverage Determination Clarification Act, HR 3635, in the House of Representatives. While the CMS adopted some of the CAP’s recommendations in the updated manual, the CAP argued the changes did not go far enough and the legislation was still needed. Congress should ensure coverage decisions are made by qualified health experts, through a transparent process, based on sound medical evidence that’s not used selectively. The CAP will continue to engage with the CMS on important issues related to Medicare LCD reform.

Read the LCD legislation issue brief.

Read about LCD reform in STAT.

Download an infographic about the LCD Clarification Act.

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