Certified Revenue Cycle Representative (CRCR) Practice Exam

Which statement is true regarding local coverage determinations?

1. They are used for all types of diagnosis and procedures

2. They are established to determine coverage for specific regional healthcare services

3. They must be pre-approved by Medicare before applying

4. They relate strictly to emergency healthcare situations

The correct answer is: They are established to determine coverage for specific regional healthcare services

Local coverage determinations (LCDs) are policies developed by Medicare to specify whether particular services, procedures, or items are covered in specific geographic areas. These determinations are based on the medical necessity and appropriateness of certain healthcare services for the Medicare population within a local jurisdiction. The correct assertion is that they are established to determine coverage for specific regional healthcare services. This means that the application of these determinations can vary from one region to another, addressing the unique healthcare needs of different populations. Other options do not represent the nature of LCDs accurately. While they can apply to many diagnoses and procedures, they are not universally applicable to all types, as some may not have specific LCDs. Furthermore, LCDs do not require pre-approval from Medicare; they are published and can be referenced directly. Lastly, they do not relate strictly to emergency healthcare situations; rather, they encompass a wide range of services that may be needed in both routine and emergency settings.