When a Request for an Advance Determination of Coverage

150.5.2.2 - When a Request for an Advance Determination of Coverage Is Mandatory (Rev. 1186, Issued: 02-23-07; Effective: 01-01-06; Implementation: 05-23-07) A request for an advance determination of coverage of medical equipment and supplies is mandatory under §1834(a)(15)(C)(i) & (ii) of the Act, respectively, when: • The item is on the list developed by the Secretary under §1834(a)(15)(A) of items which are frequently subject to unnecessary utilization in your contractor service area; or • The supplier is on the list developed by the Secretary under §1834(a)(15)(B) of the Act of suppliers for which a substantial number of claims have been denied as not medically reasonable and necessary under §1862(a)(1) of the Act or the Secretary has identified a pattern of overutilization resulting from the business practice of the supplier.