Medical Billing Terms K-L: LCD Billing Terms and Licensure Compact

LCD billing terms start with the local coverage determination (LCD), a decision by a Medicare Administrative Contractor on whether a service is covered in its region. This page defines the LCD and the K and L terms, including LCA, LEIE, limiting charge, licensure compact and long-acting injectable administration. Each entry gives a plain definition, why it matters, an example, and an official source. MCM South Medical Billing Service, LLC works only in mental and behavioral health billing.

Last reviewed: October 10, 2026Sources linked at each term

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Billing Terms Glossary slide, Terms K-L: LCD Billing Terms - MCM South Medical Billing Service, LLC

Glossary pages

0-9 A B C D E F G H I JK-LM N-O P Q-R S T U-V W-Z

On this page (14 terms)

Kaiser Permanente
Kareo
Key Performance Indicator (KPI)
LEIE (List of Excluded Individuals/Entities)
Letter of Medical Necessity
Level of Care
Licensed Professional Counselor (LPC)
Licensure Compact
Limited English Proficiency (LEP)
Limiting Charge
Linking a Provider to a Group
Local Coverage Article (LCA)
Local Coverage Determination (LCD)
Long-Acting Injectable (LAI) Administration

How to use these LCD Billing Terms definitions

Use this page as a quick reference for Local Coverage Determination, from Kaiser Permanente to Long-Acting Injectable. Each entry gives a plain definition, why it matters to a mental health practice, and an official source. When a rule changes by payer or state, the entry says so, so confirm Local Coverage Determination details with the payer before you bill.

Checklist: put the lcd billing terms definitions to work

Check the lcd billing terms entries above before you send a claim that depends on them.
Share this lcd billing terms page with front-desk and billing staff so everyone works from the same definitions.
When a payer letter mentions lcd billing terms, find the matching entry and note the date you checked it.
Keep your lcd billing terms notes next to your payer contracts, because a contract can define a term differently.
Ask the payer to confirm in writing how it applies lcd billing terms before you change a workflow.
Train new staff on lcd billing terms first, then move on to the rest of the glossary.
Log any lcd billing terms question that comes up twice, then add the answer to your billing procedures.
Use the source links under the lcd billing terms entries to confirm the current rule.
Print the lcd billing terms entries you use most and keep them at the billing desk.
Review your lcd billing terms notes each quarter, because payer and CMS rules change.
Mark where lcd billing terms work differently for psychotherapists and for psychiatrists in your own procedures.

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Kaiser Permanente

Private payer

Also called Kaiser; KP

Definition: An integrated health system and health plan, where members generally get care from Kaiser providers and contracted providers only when referred.
Why it matters: Community providers usually need a referral or contract.
Illustrative example: A Kaiser member needs authorization to see an outside therapist.

Reference sourceKaiser Permanentechecked 10/9/26

CategoriesBCBS, UHC & Commercial Payer Terms

Kareo

General (all payers)

Also called Kareo EHR

Definition: A legacy name for a practice management and EHR vendor that became part of the Tebra brand. Listed for reference; not an endorsement or partnership.
Why it matters: Older documents and payer records may still use the name.
Illustrative example: A payer file lists Kareo as the software vendor.

Related termsTebra Practice Fusion

Reference sourceTebrachecked 10/9/26

CategoriesEHR & Healthcare Technology Terms

Key Performance Indicator (KPI)

General (all payers)

Also called KPI; billing KPI

Definition: A measurable value that shows how well a process is performing against a goal.
Why it matters: Consistent KPIs make trends visible.
Illustrative example: A billing dashboard tracks denial rate and days in A/R.

Related termsDays in A/R Denial Rate

Reference sourceHFMAchecked 10/9/26

CategoriesRevenue Cycle Metrics

LEIE (List of Excluded Individuals/Entities)

General (all payers)

Also called LEIE; exclusion list; OIG exclusion

Definition: The OIG list of individuals and entities excluded from federal health care programs.
Why it matters: Billing for services by an excluded person can lead to penalties.
Illustrative example: A group checks each new hire against the list.

Reference sourceHHS Office of Inspector General (OIG)checked 10/9/26

CategoriesAudits & Compliance

Letter of Medical Necessity

General (all payers)

Also called LMN; medical necessity letter

Definition: A letter from a clinician explaining why a service is needed for a patient's condition, used in prior authorization and appeals.
Why it matters: Specific, patient-focused letters carry more weight than generic ones.
Illustrative example: A therapist writes an LMN describing symptoms, prior treatment, and treatment goals.

Reference sourceCMS (Centers for Medicare & Medicaid Services)checked 10/9/26

CategoriesDenials & Appeals

Level of Care

General (all payers)

Also called LOC; outpatient level of care; IOP; PHP

Definition: The intensity and setting of treatment, from outpatient to intensive outpatient, partial hospitalization, residential, and inpatient.
Why it matters: Payers authorize by level of care using criteria.
Illustrative example: A payer approves intensive outpatient instead of partial hospitalization.

Reference sourceAmerican Psychiatric Associationchecked 10/9/26

CategoriesPrior Authorization Terminology Behavioral Health Specific Terms

Licensed Professional Counselor (LPC)

General (all payers)

Also called LPC; LCPC; LPCC; LMHC; licensed clinical professional counselor; licensed mental health counselor

Definition: A licensed professional counselor is a master's-level or higher clinician licensed by a state to provide counseling and psychotherapy. The exact title differs by state, such as LPC, LCPC, LPCC, or LMHC.
Why it matters: Payers credential counselors by license type and have different rules for each. Medicare recognizes counselors who meet its mental health counselor definition.
Illustrative example: An LPC enrolls with commercial plans as a counselor and, if eligible, with Medicare as a mental health counselor.

Reference sourceAmerican Counseling Association CMS Medicare Learning Network (MLN)checked 10/9/26

CategoriesCredentialing & Enrollment Behavioral Health Specific Terms

Licensure Compact

General (all payers)

Also called interstate compact; PSYPACT; Counseling Compact

Definition: An agreement among states that lets qualifying clinicians practice across participating states without a separate license in each. Examples include compacts for psychologists and counselors.
Why it matters: Affects which patients a clinician can treat by telehealth and which states a practice can serve.
Illustrative example: A psychologist uses an interstate practice authorization to treat a patient in another member state.

Reference sourceHHS (U.S. Department of Health and Human Services)checked 10/9/26

CategoriesCredentialing & Enrollment Telehealth Terms

Limited English Proficiency (LEP)

General (all payers)

Also called LEP; language access; interpreter services

Definition: Limited English Proficiency describes a person who does not speak English as a primary language and has a limited ability to read, speak, write, or understand it. Federal rules can require covered health programs to provide language assistance.
Why it matters: Plan how you will offer interpreters and translated materials. Bilingual staff can help, but check whether they are qualified to interpret clinical content.
Illustrative example: A practice arranges a qualified interpreter for a Spanish-speaking patient's intake.

Reference sourceHHS (U.S. Department of Health and Human Services)HHS Office for Civil Rights (OCR)checked 10/9/26

CategoriesAudits & Compliance

Limiting Charge

Medicare

Also called Medicare limiting charge; 115 percent rule

Definition: The limiting charge is the most a non-participating Medicare provider can bill a patient for a covered service that the provider does not accept assignment for. It is set as a percentage above the Medicare fee schedule amount.
Why it matters: It applies only to non-participating providers and only to certain provider types. Check whether it applies to your license type, and do not balance bill beyond it.
Illustrative example: A non-participating provider checks the limiting charge before billing a patient the difference above Medicare's approved amount.

Reference sourceCMS (Centers for Medicare & Medicaid Services)checked 10/9/26

CategoriesMedicare & Medicaid Terms Payment & Reimbursement

Linking a Provider to a Group

General (all payers)

Also called provider linkage; reassignment of benefits

Definition: Associating an individual clinician's NPI with a group's billing NPI and tax ID at a payer, so claims pay to the group.
Why it matters: Missing linkage causes the claim to reject or pay to the wrong entity.
Illustrative example: A payer approves an individual but the group linkage is still pending; claims are held.

Reference sourceCMS (Centers for Medicare & Medicaid Services)checked 10/9/26

CategoriesCredentialing & Enrollment Contracting & Network Management

Local Coverage Article (LCA)

Medicare

Also called LCA; billing and coding article; Medicare contractor article

Definition: A local coverage article is a Medicare contractor document that gives billing and coding guidance that goes with a local coverage determination. Many carry an identifier that starts with the letter A, such as A57480.
Why it matters: Articles tell you which codes, modifiers, and diagnoses a Medicare contractor expects. They apply only in that contractor's jurisdiction.
Illustrative example: A biller reads the contractor's article to see how the MAC wants psychotherapy start and stop times documented.

Reference sourceCMS (Centers for Medicare & Medicaid Services)CMS Coverage Database, Article A57480 (WPS)checked 10/9/26

CategoriesMedicare & Medicaid Terms Claims Processing

Local Coverage Determination (LCD)

Medicare

Also called LCD; local coverage article; LCA

Definition: A decision by a MAC about whether a service is covered in its jurisdiction, often with billing and documentation articles.
Why it matters: Rules differ by MAC jurisdiction.
Illustrative example: A MAC's article lists required documentation for psychotherapy.

Reference sourceCMS (Centers for Medicare & Medicaid Services)checked 10/9/26

CategoriesMedicare & Medicaid Terms

Long-Acting Injectable (LAI) Administration

General (all payers)

Also called LAI; long-acting injectable; injection administration; 96372

Definition: A long-acting injectable is a psychiatric medication given by injection at intervals of weeks or months. A practice bills the drug and the administration separately, with the injection administration code and the drug's HCPCS code.
Why it matters: Payers have specific rules on drug codes, units, buy-and-bill versus pharmacy benefit, and prior authorization. Check them before you stock the drug.
Illustrative example: A psychiatry practice confirms coverage and prior authorization before giving a patient a monthly injection.

Reference sourceAmerican Psychiatric Association American Medical Association (AMA)checked 10/9/26

CategoriesBehavioral Health Specific Terms Claims Processing

Quick answer: LCD Billing Terms

What is a local coverage determination (LCD)?

Local Coverage Determination (LCD) is a decision by a MAC about whether a service is covered in its jurisdiction, often with billing and documentation articles. Rules differ by MAC jurisdiction.

Frequently asked questions: LCD Billing Terms

What is the LEIE?

The OIG list of individuals and entities excluded from federal health care programs. Billing for services by an excluded person can lead to penalties.

What is the Medicare limiting charge?

The limiting charge is the most a non-participating Medicare provider can bill a patient for a covered service when the provider does not accept assignment. It is set as a percentage above the Medicare fee schedule amount.

How is long-acting injectable administration billed?

A long-acting injectable is a psychiatric medication given by injection at intervals of weeks or months. A practice bills the drug and the administration separately, with the injection administration code and the drug's HCPCS code.

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Where MCM South works

MCM South serves psychotherapists and psychiatrists in ten states: Georgia, Massachusetts, Connecticut, Texas, Florida, New York, Colorado, Tennessee, North Carolina and Illinois.

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