Inconsistent Medicare Part B local coverage determinations (LCDs) create disparities in Medicare beneficiary access to items and services, a recent OIG report concludes. The OIG focused on LCDs issued by MACs for Part B items and services performed by noninstitutional providers (e.g., medical procedures, evaluation and management services, imaging services, drugs, and tests), but excluded LCDs for durable medical equipment. Among other things, the OIG observed that as of October 2011, over half of the 7,500 Part B procedure codes reviewed were subject to an LCD in one or more states – but LCDs affected coverage for over 50% of codes in some states but as few as 5% in other states. These LCDs limited coverage for these items and services differently across the states, and defined similar clinical topics inconsistently. The OIG observes that while MACs may have developed LCDs for particular procedure codes to address local situations, including overuse or misuse of items or services, as a result “beneficiaries’ access to items and services can depend on geography as much as their clinical indications.”  One third of the codes reviewed that were subject to a noncoverage LCD involved new technologies.  The OIG recommends that CMS: establish a plan to evaluate new LCD topics for national coverage; continue efforts to increase consistency among existing LCDs; and consider requiring MACs to jointly develop a single set of coverage policies. CMS generally agreed with the OIG on the benefits of achieving greater LCD consistency, although CMS noted that there were hurdles associated with requiring joint development of policies (ranging from administrative burdens, beneficiary appeals rights, and state scope of practice laws).