To help you successfully meet the requirements for put forth by your Medicare Administrative Contractor, the Academy has provided the applicable local coverage determination policies for each U.S. state and some territories. Each policy below can also be found at cms.gov.
To search the alphabetical list of National Coverage Determinations, visit the Centers for Medicaid & Medicare Services website.
Excerpts from NCD 80.11 Vitrectomy
Medicare Administrative Contractors
The Academy is not responsible for the contents or accuracy of these policies, but maintains this listing as a service to members. For questions about a policy, contact your carrier.
- Cigna Government Services: Kentucky, Ohio
- First Coast Service Options: Florida, Puerto Rico, Virgin Islands
- National Government Services
- JK- Connecticut, Maine, Massachusetts, New Hampshire, New York, Rhode Island and Vermont
- J6- Illinois, Minnesota and Wisconsin
- Noridian
- JE- California, Hawaii, Nevada, American Samoa, Guam, Northern Mariana Islands
- JF- Alaska, Arizona, Idaho, Montana, North Dakota, Oregon, South Dakota, Utah, Washington, Wyoming
- Novitas
- JL- Pennsylvania, New Jersey, Maryland, Delaware and the District of Columbia
- JH- Texas, Oklahoma, Colorado, New Mexico, Arkansas, Louisiana, Mississippi
- Palmetto:
- JJ- Alabama, Georgia, Tennessee
- JM- North Carolina, South Carolina, Virginia and West Virginia
- WPS Government Health Administrators
- J5- Iowa, Kansas, Missouri, and Nebraska
- J8- Indiana and Michigan
Why Can't I Find My State?
If your state does not have a policy included, you should clearly document medical necessity. Consider reviewing other states' policies for guidance. Each policy includes an effective date, which is important as policies are continually updated.