Medicare Program Integrity Manual (Pub. 100-08), Ch. 13 § 13.2.3
Clinical Guidelines, Consensus Documents and Consultation
13.2.3 - Clinical Guidelines, Consensus Documents and Consultation
(Rev. 863; Issued: 02-12-19; Effective: 10-03-18; Implementation: 01-08-19)
Prior to drafting and during the development of an LCD, if available the MACs shall supplement
their research (see section 13.5.3) with clinical guidelines, consensus documents or consultation
by experts (recognized authorities in the field), medical associations or other health care
professionals for an advisory opinion, when applicable. When a MAC consults with an expert,
they shall inform and obtain consent from the expert that their opinion may be used, disclosed
publicly, and clearly identified as such within the proposed or final LCD. Acceptance by
individual health care providers, or even a limited group of health care providers, does not
indicate general acceptance of the item or service by the medical community.