Why Knowing Your MAC Region (and LCDs) Matters in Wound Care

Nikki Johnston
Jun 23
2 min read

If you’re involved in wound care—whether you're running a mobile practice, outpatient clinic, or part of a larger healthcare system—one of the most overlooked keys to success is understanding your MAC region and the Local Coverage Determinations (LCDs) that govern it.

Let’s break it down.

🗺️ What Is a MAC Region?

MAC stands for Medicare Administrative Contractor. These are private organizations contracted by CMS (Centers for Medicare & Medicaid Services) to process claims, enforce billing policies, and oversee medical review within designated geographic areas.

There are seven Part A/B MACs across the United States, and each is responsible for developing its own LCDs—which means your billing and documentation expectations can vary significantly depending on where you practice.

📋 What Is an LCD?

An LCD (Local Coverage Determination) is a policy published by a MAC that outlines what services are covered, under what conditions, and what documentation is required to support medical necessity.

In wound care, LCDs commonly address services like:

Application of skin substitutes
Debridement (surgical, enzymatic, mechanical)
Use of Negative Pressure Wound Therapy (NPWT)
Frequency of treatment
Medical necessity and staging documentation

Ignoring or misinterpreting these guidelines can lead to denials, audits, and clawbacks—even when the clinical care is appropriate.

⚠️ Why It Matters

Here’s the reality:The exact same service can be covered in one region and denied in another, based solely on how the LCD is written.

Example:

In Novitas (which covers Texas, Pennsylvania, and others), skin substitutes have specific reapplication timeframes and staging documentation requirements.
Noridian or Palmetto may require slightly different modifiers or frequency limitations.
CGS may require photographic documentation or specific coding nuances.

This is especially critical for multi-state mobile wound care providers, healthcare systems expanding across MAC regions, or practices using outsourced billing teams unfamiliar with local nuances.

✅ How Kindling Consulting Helps

At Kindling Consulting, we make it our business to understand not just the clinical side of wound care—but the operational, regulatory, and billing sides too.

We help organizations: