Medicare Coverage Database Guide – How to Find What You Need

The Medicare coverage database (MCD) is quite complex and can be difficult to navigate, especially for new users. It is a searchable database that details what is covered and not covered by the Medicare program.

It contains different types of documents, including:

• Local Coverage Determinations (LCDs)
• (NCDs), National Coverage Analyses (NCAs)
• Proposed LCDs
• Draft Articles
• Local Coverage Articles
• National Coverage policy-related documents such as Medicare coverage guidance documents, Medicare Evidence Development & Coverage Advisory Committee (MEDCAC) proceedings, and Coding Analyses for Labs (CALs), among others.

Who Can Use the Medicare Coverage Database?

The MCD is mainly designed for use by healthcare providers, personnel, and suppliers. A healthcare provider can use it to understand the scope of coverage before providing medical equipment, items, or services to Medicare beneficiaries. 

CMS also expects each medical and health care provider to deliver the correct services to prevent incidences of payment denial.

If the healthcare provider does not explicitly notify Medicare beneficiaries that the service or treatment they seek by their doctors may be denied, they are financially liable for any expenses incurred. The notice should be given to Medicare beneficiaries in advance in written form.

On the other hand, patients and family members should use the official Medicare program website —Medicare.gov, to find information on enrollment, benefits, and other tools.

Steps for Using the Database

Access the MCD Webpage

The MCD can be accessed in either of the following two ways. First, through the CMS website. Click the “MCD, Medicare Coverage Database” icon on the menu bar on the CMS website home page. Or, you can search for the MCD webpage on your browser. 

Enter Your Search Term

To conduct your search, start by entering a general word that describes what you are looking for in the search box. It could also be a document ID or an HCPSC code.

A hint list will pop up as you enter the search term, ID, or procedure code, displaying potential matches. Select the most appropriate one from the drop-down options or proceed with the search.

Accept the AMA License Agreement, Where Applicable

If there is a yellow AMA license agreement bar, click on it to accept the terms and conditions to enter the database.

Narrow Down Your Search Results

You can narrow your search results by adjusting the keyword or selecting the relevant options, including document type, state, and Medicare contractor.

The documents are categorized into two main groups: All National Coverage and All Local Coverage.

The indicated document types for All National Coverage are:

• NCAs (National Coverage Analyses)
• CALs (Coding Analyses for Labs)
• NCDs (National Coverage Determinations)
• MEDCACs (Medicare Evidence Development & Coverage Advisory Committee Meetings)
• TAs (Technology Assessments)
• MCDs (Medicare Coverage Documents)

While the indicated document types for All Local Coverage are:

• All Articles
• B&C (Billing and Coding) Articles
• SAD (Self-Administered Drug Exclusion) Articles
• RTC (Response to Comment) Articles
• All Other Articles
• All LCDs (Policies)
• Final LCDs (Final Policies)
• Proposed LCDs (Proposed Policies)

You can select the specific document type or categories or search the database for all types of documents.

To narrow your search options by state, choose your state or one of the 10 CMS regions.

The search options for contractors are:

• All Contractors
• Contractor Number
• Contract Type
• Contractor Name

There is also a more search option that includes the following options:

• NCA/CAL Status (NCAs and CALs only)
• Benefit Category (NCAs, CALs, and NCDs only)
• CPT/HCPCS (Local Coverage only)
• ICD-10-CM (Local Coverage only)
• Date Criteria
• Article/LCD Status (Articles and LCDs only)

Finally, you can narrow the search results by relevance, title, document type, contractor, and the latest updates. Once you have customized your search results, launch the search by clicking on the green search icon at the end of the keyword search bar.

Select the Most Suitable Result

Scroll down the search results to identify the most suitable one. Click on it to view the details. You may also download the search results from the bottom of the page as an excel sheet for future reference.

Tips for Using the MCD

Always Check if it Has Been Updated

Even if you have used the MCD before and think you are well-conversant with it, always check the help and resources page for any updates in the website and search process.

For example, a Local Coverage Determination (LCD) tracking sheet was recently added. There is also a new section that includes all Medicare coverage document types.

Typically, CMS updates the national coverage information on the database in real-time. On the other hand, local coverage information is updated on a weekly basis. It is captured at Sunday midnight but reflects on the MCD the following Thursday.

Local and national coverage download files are updated weekly on Thursdays. Users can also opt into the MAC website mailing list for notifications of new or changes in the LCDs.

Refer to the Help and Resources Page for More Information

The help centers and resources page also provides information on the latest site updates, how-to library, Notice board, MCD data schedule, MCD archive, coverage document descriptions, local coverage info, etc. The help and resources page can be accessed by clicking on the question mark icon on the MCD homepage.

Use the Latest Version of the Supported Browsers

For full access to the MCD, use the latest version of the supported browser. CMS supports the following browsers: Safari, Google, Firefox, and Edge.

Conclusion

The MCD database is freely accessible to Medicare service and healthcare providers and suppliers to counter-check covered items and services. It can seem complicated at a glance but is quite easy to use, as described above.

However, keep in mind that the database and CMS website are regularly updated. Therefore, ensure to check for the latest updates. Also, use the latest version of one of the supported browsers to access the website.

You can find more information on how to navigate the database on the Help & Resources page of the MCD.