Sep 1, 2023

BlueCHiP for Medicare national and local coverage determinations policy

BCBSRI must follow CMS guidelines for national coverage determinations (NCDs) or local coverage determinations (LCDs). Therefore, policies for BlueCHiP for Medicare may differ from policies for commercial products. In some instances, benefits for BlueCHiP for Medicare may be greater than what is allowed by CMS.

In the absence of an applicable NCD, LCD, or other CMS-published guidance, BCBSRI will apply policy determinations developed using peer-reviewed scientific evidence. BCBSRI will continually review NCD and LCD updates and implement appropriate policy changes.

Due to the ongoing effort to follow CMS guidelines for NCDs and LCDs, many BCBSRI policies are now applicable to commercial products only. In these instances, please refer to BlueCHiP for Medicare’s NCD and LCD policies for further information on BlueCHiP for Medicare coverage.