MCD Beneficiary Guide

Guide to the MCD Search for Beneficiaries

Introduction

You can use the MCD to find coverage documents. These documents explain the benefits covered by Medicare. If you had a service denied, these documents will assist with understanding your denial.

This brief guide explains how to use the MCD Search to find the documents you need.

Navigating the MCD

The MCD is divided into multiple sections which you will find in the blue navigation bar.

The section you need is "Search".

MCD Search

Use the MCD Search to search for documents. On the Search page, you will find a textbox to enter your search terms.

You can enter keywords into the textbox (e.g., "acupuncture") to explore certain topics.

As a beneficiary, you are most likely on this site because you have questions on either: 1) a Policy or Document ID, or 2) a billing or procedure code. Perhaps a claim of yours was denied. The denial should include one of these you can use to find the relevant coverage documents.

Search by Policy or Document ID

Find the ID

The first step is to identify a Policy or Document ID. If you have a Medicare Summary Notice (MSN) or Explanation of Benefits (EOB) then you should find the Policy or Document ID in the notes section, if one is listed. It might be referred to as a Local Coverage Determination (LCD).

The ID may look like one of these examples:

L99999 (LCD ID: 6 characters starting with the letter "L")
A99999 (Article ID: 6 characters starting with the letter "A")
99.9.9 (NCD ID: All numbers separated by periods)

See an example of an MSN that displays Document IDs

Enter the ID

Once you find the ID, enter it in the text box. You should see the matching document in the hint list below the text box. Click on it and the MCD will open your document.

Example of entering document ID in the search textbox

Search by Billing or Procedure Code

Find the Code

If you do not have a Policy or Document ID then look for a procedure code, sometimes referred to as a billing code. Often the codes are listed inside parentheses like this - "(98940)". If a service was denied, use the code that pertains to the denial. These codes may also be referred to as CPT, HCPCS, or dental code.

The codes are 5-digits long and may either be all numbers as in "98940" or may have a letter at the start or end as in "M1003" and "0000U". If the code includes a dash after the 5-digit code, "98940-XX", then omit the dash and anything after the dash. In this example, only enter "98940".

See examples of MSNs that display where to find billing or procedure codes:

Enter the Code

Once you find the code, enter it in the textbox...

Example of entering a billing code into the search textbox

Then select the state where service was performed...

If you see a yellow box as in below, click on it...

Clicking on the license agreement notification bar

Then click on the Accept button in the license agreement popup...

You should now see the code in the hint list below the text box. Clicking on the code will return a list of local coverage documents that include the entered code.

Example of entering a billing code and the hint list appearing

Special Note about National Coverage Documents
Please note that only local coverage documents are returned by a code search. To find relevant national coverage documents, perform a keyword search using a term that is relevant to your code or area of interest. For example, the description for code 98940 is "CHIROPRACTIC MANIPULATIVE TREATMENT (CMT)". After a code search on 98940 to find local coverage documents, you can perform a new search using a term such as "chiropractic" to find national coverage documents.