Glossary
Coverage words, plainly
Definitions for the words on the coverage pages. They describe the CMS documents and the signed answer. They are not coding advice.
Policy pages were read from the CMS Coverage API on 2026-10-13.
HCPCS
Healthcare Common Procedure Coding System. Level II codes, a letter and four digits, identify equipment, supplies, and related items. CMS maintains Level II. These pages use the code as the CMS LCD code table lists it.
LCD
Local Coverage Determination. A Medicare Administrative Contractor's decision about whether an item is reasonable and necessary in its jurisdiction. The LCD pages here are the current final LCDs the CMS Coverage API reports for the DME MACs, CGS Administrators and Noridian Healthcare Solutions.
NCD
National Coverage Determination. A national Medicare coverage decision published in the Medicare National Coverage Determinations Manual, CMS Publication 100-03. An NCD applies everywhere an LCD does not narrow it.
DME
Durable medical equipment. A Medicare benefit category under section 1861(s)(6) of the Social Security Act, for equipment that meets the statutory definition. These pages are the DME MAC policies, not every Medicare benefit.
DME MAC
A Medicare Administrative Contractor that processes durable medical equipment claims. CGS Administrators and Noridian Healthcare Solutions issue the DME MAC local coverage determinations together.
Policy article
A Medicare Coverage Database article linked from an LCD. Billing and coding rules often sit in the policy article, and standard documentation rules often sit in a separate documentation article.
Documentation requirements
The records an LCD or its article says the file must contain. A code page quotes that text when the CMS document has it, and links the CMS article. It does not add a checklist the document does not contain.
Denial
A decision that Medicare will not pay a claim. Where an LCD or NCD states that a claim will be denied, the page quotes that sentence and names the document. Sentences about a different HCPCS code are not copied onto this code.
Date of service
The day the rule is applied. Coverage text on these pages is the current final document from the CMS read date in the page header. A signed answer from the API is resolved to the version in force on the date of service you send.
Receipt
A signed answer: the answer, the source that was in force, and a hash you can replay. It is a receipt for the published rule, edit, fee, and standing. It is not a guarantee of payment or of medical necessity.
Medicare
The federal program these pages describe. The text is from Medicare DME MAC LCDs and from National Coverage Determinations.
Medicaid
State medical assistance programs. These pages do not state Medicaid coverage. The signed answer is live for Medicare DME. Medicaid comes later, and a page will not invent a state rule in the meantime.
RCM
Revenue cycle management. RCM teams, DME suppliers, and payers use the same published rule. The pages and the API are a shared source for that rule.