Local Coverage Determination (LCD) Reconsideration Process
The Local Coverage Determination (LCD) Reconsideration Process is a mechanism by which interested parties can request a revision to a LCD. This contractor will consider all LCD reconsideration requests from:
- Beneficiaries residing or receiving care in this contractor's jurisdiction;
- Providers doing business in this contractor's jurisdiction: and
- Any interested party doing business in this contractor’s jurisdiction.
This contractor will only accept reconsideration requests for LCDs posted in final form. Requests will not be accepted for other documents including:
- National Coverage Decisions (NCD);
- Coverage provisions in interpretive manuals;
- Draft LCDs;
- Template LCDs, unless or until they are adopted by the contractor;
- Retired LCDs;
- Individual claim determinations;
- Bulletins, articles, training materials; and
- Any instance in which no LCD exists, (i.e., requests for development of an LCD.)
If modification of the LCD would conflict with a NCD, the request would not be valid. Providers should refer to the NCD reconsideration process.
Process
Requests must be submitted in writing, and must identify the language that the requestor wants added to or deleted from a LCD. Requests must include a justification supported by new evidence, which may materially affect the LCD’s content or basis. Copies of published evidence must be included. The request may be sent by mail, e-mail or fax. Go to the Contact Us page and select “Write Us” for information on submitting LCD reconsiderations in writing or via e-mail.
The level of evidence required for LCD reconsideration is the same as that is required for new/revised LCD development. Any request for LCD reconsideration that, in the judgment of the contractor, does not meet these criteria is invalid.
Contractors have the discretion to consolidate valid requests if similar requests are received. Within 30 days of the day the request is received, the contractor will determine whether the request is valid or invalid.
If the request is invalid, the contractor will respond, in writing, to the requestor explaining why the request was invalid.
If the request is valid, the contractor will follow the requirements below.
- Within 90 days of the day the request was received, the contractor will make a final LCD reconsideration decision on the valid request and notify the requestor of the decision with its rationale. Decision options include retiring the policy, no revision, revision to a more restrictive policy, or revision to a less restrictive policy.
- If the decision is either to retire the LCD or to make no revision to the LCD, then within 90 days of the day the request was received, the contractor will inform the requestor of that decision with its rationale.
- If the decision is to revise the LCD, the normal process for LCD development will be followed.
Page last updated: May 9, 2008