Medicare Program Integrity Manual (Pub. 100-08), Ch. 13 § 13.2.4

Proposed LCD

Last amended: 2019Year: 2019Length: 218 wordsOfficial source
13.2.4 - Proposed LCD (Rev. 863; Issued: 02-12-19; Effective: 10-03-18; Implementation: 01-08-19) All proposed LCDs, with limited exceptions noted below, must follow the LCD process outlined in 13.2 of this manual, consisting of consultation, publication of proposed LCD, open meeting concerning the proposed policy, opportunity for public comment in writing, publication of a final LCD that includes a response to public comments received and notice to public of new policy 45 days in advance of the effective date. These processes shall be used for all LCDs except in the following situations: • Revised LCD Being Issued for Compelling Reasons - • Revised LCD that Makes a Non-Substantive Correction - For example, typographical or grammatical errors that do not substantially change the LCD. • Revised LCD that Makes a Non-Discretionary Coverage Update - Contractors shall update LCDs to reflect changes in Statutes, Federal regulations, CMS Rulings, NCDs, HCPCS code changes for DME, coverage provisions in interpretive manuals, and payment policies. • Revise LCD to effectuate an Administrative Law Judge’s decision to nullify an existing LCD due to an LCD Challenge. Contractors must obtain explicit approval from the CMS Contracting Officer Representative (COR) and Business Function Lead (BFL) in all other situations (e.g. there is compelling new evidence that a procedure/device is highly unsafe and coverage must be removed immediately).
Medicare Program Integrity Manual (Pub. 100-08), Ch. 13 § 13.2.4: Proposed LCD | Justis AI