Local Coverage Determinations
E500282
Local Coverage Determinations are Medicare administrative policies issued by regional contractors that define whether specific medical services or items are considered reasonable and necessary, and therefore covered, within their jurisdictions.
All labels observed (1)
| Label | Occurrences |
|---|---|
| Local Coverage Determinations canonical | 2 |
How this entity was disambiguated
This entity first appeared as the object of triple T5166922 — resolving that mention is where its identity was fixed. The disambiguator weighed these candidate entities and picked the highlighted one (or “None”, minting a new entity). This is how homonymy is resolved: the same surface form can point to different entities.
NED1
Entity disambiguation (via context triple)
gpt-5-mini-2025-08-07
Target entity: Local Coverage Determinations Context triple: [National Coverage Determinations, relatedTo, Local Coverage Determinations]
-
A.
National Coverage Determinations
National Coverage Determinations are nationwide Medicare policies that define whether and under what conditions specific medical services, procedures, or technologies are covered for beneficiaries.
-
B.
Local Volume
The Local Volume is the nearby region of the universe encompassing galaxies within roughly 10 megaparsecs of the Milky Way, used to study the structure, dynamics, and evolution of the local cosmos.
-
C.
local coordination committees
Local coordination committees are grassroots activist networks in Syria that organize protests, document abuses, and coordinate civil resistance against the Assad regime.
-
D.
state Disability Determination Services
State Disability Determination Services are state-level agencies that evaluate medical evidence and make initial disability eligibility decisions for federal Social Security disability programs.
-
E.
Local Fields
"Local Fields" is a foundational mathematical text by Jean-Pierre Serre that develops the theory of local fields and their applications in number theory and algebraic geometry.
- F. None of above. chosen
- G. Unsure - the case is ambiguous/there is not enough information to decide.
NED2
Entity disambiguation (via description)
gpt-5-mini-2025-08-07
Target entity: Local Coverage Determinations Target entity description: Local Coverage Determinations are Medicare administrative policies issued by regional contractors that define whether specific medical services or items are considered reasonable and necessary, and therefore covered, within their jurisdictions.
-
A.
National Coverage Determinations
National Coverage Determinations are nationwide Medicare policies that define whether and under what conditions specific medical services, procedures, or technologies are covered for beneficiaries.
-
B.
Local Volume
The Local Volume is the nearby region of the universe encompassing galaxies within roughly 10 megaparsecs of the Milky Way, used to study the structure, dynamics, and evolution of the local cosmos.
-
C.
local coordination committees
Local coordination committees are grassroots activist networks in Syria that organize protests, document abuses, and coordinate civil resistance against the Assad regime.
-
D.
state Disability Determination Services
State Disability Determination Services are state-level agencies that evaluate medical evidence and make initial disability eligibility decisions for federal Social Security disability programs.
-
E.
Local Fields
"Local Fields" is a foundational mathematical text by Jean-Pierre Serre that develops the theory of local fields and their applications in number theory and algebraic geometry.
- F. None of above. chosen
Statements (50)
| Predicate | Object |
|---|---|
| instanceOf |
Medicare coverage policy
ⓘ
administrative determination ⓘ |
| appliesTo |
Medicare Fee-for-Service program
ⓘ
linked to:
Medicare
Part A Medicare services ⓘ Part B Medicare services ⓘ |
| canBeChallengedIn | federal district court under certain conditions ⓘ |
| comparableTo | National Coverage Determinations ⓘ |
| country |
United States
ⓘ
linked to:
United States of America
|
| defines |
clinical indications for use
ⓘ
coding requirements ⓘ coverage criteria for specific items and services ⓘ documentation requirements ⓘ limitations of coverage ⓘ reasonable and necessary conditions for coverage ⓘ |
| differsFrom | National Coverage Determinations by being local rather than national in scope ⓘ |
| governingBody | Centers for Medicare & Medicaid Services ⓘ |
| issuedBy |
MACs
ⓘ
Medicare Administrative Contractors ⓘ |
| jurisdiction | Medicare Administrative Contractor jurisdictions ⓘ |
| legalBasis |
Medicare Program Integrity Manual
ⓘ
Section 1862(a)(1)(A) of the Social Security Act ⓘ |
| mayInclude |
diagnosis codes that support medical necessity
ⓘ
procedure codes covered or noncovered ⓘ rationale for coverage decision ⓘ supporting clinical literature ⓘ |
| objective |
define when services are considered reasonable and necessary for diagnosis or treatment
ⓘ
ensure consistent application of Medicare coverage rules within a jurisdiction ⓘ |
| overriddenBy | National Coverage Determinations when conflict exists ⓘ |
| publishedBy |
Centers for Medicare & Medicaid Services website
ⓘ
linked to:
Centers for Medicare & Medicaid Services
|
| publishedOn | Medicare Coverage Database ⓘ |
| regulates |
payment for diagnostic tests
ⓘ
payment for drugs and biologics under Part B ⓘ payment for durable medical equipment ⓘ payment for specific medical procedures ⓘ |
| relatedTo | coverage articles that provide additional billing and coding guidance ⓘ |
| requires |
public notice and comment process for new or revised policies
ⓘ
publication of final LCDs ⓘ publication of proposed LCDs ⓘ |
| scope |
does not apply nationally
ⓘ
limited to contractor jurisdiction ⓘ |
| subjectTo |
appeal rights by beneficiaries and providers
ⓘ
federal Medicare statutes and regulations ⓘ |
| targetAudience |
Medicare beneficiaries
ⓘ
healthcare providers ⓘ suppliers ⓘ |
| updatedBy | Medicare Administrative Contractors based on new evidence or policy changes ⓘ |
| usedFor |
adjudication of Medicare claims
ⓘ
guidance on medical necessity ⓘ program integrity activities ⓘ utilization management ⓘ |
How these facts were elicited
The pipeline generated the facts above by prompting gpt-5.1 with this entity's name + description and the instruction below.
Instruction
You are a knowledge base construction expert. Given a subject entity and a description of it, return factual statements that you know for the subject as a JSON list of dictionaries(triples), where keys must be "subject", "predicate" and "object". The number of facts may be very high, between 25 to 50 or more, for very popular subjects. For less popular subjects, the number of facts can be very low, like 5 or 10. # Requirements - If you don't know the subject at all, return an empty list. - If the subject is not a named entity, return an empty list. - Include at least one triple where predicate is "instanceOf". - Do not get too wordy. - Separate several objects into multiple triples with one object.
Input
Subject: Local Coverage Determinations Description of subject: Local Coverage Determinations are Medicare administrative policies issued by regional contractors that define whether specific medical services or items are considered reasonable and necessary, and therefore covered, within their jurisdictions.
Referenced by (2)
Full triples — surface form annotated when it differs from this entity's canonical label.