Valid LCD Reconsideration Request Requirements

13.3.2 - Valid LCD Reconsideration Request Requirements (Rev. 863; Issued: 02-12-19; Effective: 10-03-18; Implementation: 01-08-19) MACs shall consider all LCD reconsideration requests from: • Beneficiaries residing or receiving care in a contractor's jurisdiction; and • Providers doing business in a contractor's jurisdiction. • Any interested party doing business in a contractor's jurisdiction. MACs should only accept reconsideration requests for LCDs published as an effective final. Requests shall not be accepted for other documents including: • National Coverage Determinations (NCDs); • Coverage provisions in interpretive manuals; • Proposed LCDs; • Template LCDs, unless or until they are adopted and in effect 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 an NCD, the request would not be valid. The MAC should refer the requestor to the NCD reconsideration process. Requestors can be referred to http://www.cms.gov/DeterminationProcess/01_overview.asp#regs. Requests shall be submitted in writing and shall identify the language that the requestor wants added to or deleted from an LCD. Requests shall include a justification supported by new evidence, which may materially affect the LCD's content or basis. Copies of published evidence shall be included. Any request for LCD reconsideration that, after MAC review, is determined to not meet these criteria is invalid. MACs have the discretion to consolidate valid requests if similar requests are received.