LCD Reconsideration Process
The Local Coverage Determination (LCD) Reconsideration Process is a mechanism by which interested parties can request a revision to an LCD. The LCD Reconsideration Process is available only for final LCDs. The whole LCD or any provision of the LCD may be reconsidered.
Noridian shall consider all LCD reconsideration requests from:
- Beneficiaries residing in a contractor's jurisdiction;
- Suppliers doing business in a contractor's jurisdiction; and
- Any interested party doing business in a contractor's jurisdiction.
Noridian will only accept reconsideration requests for LCDs published in final form.
Requests shall not be accepted for other documents including:
- National Coverage Determinations (NCDs);
- 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 an NCD, the request would not be valid. For more information about the NCD processes and requesting changes to an NCD, reference https://www.cms.gov/Medicare/Coverage/DeterminationProcess/index.html .
The following steps must be followed to submit LCD reconsideration requests.
Requests must be submitted in writing by mail, fax or email.
| Noridian |
DME LCD Reconsiderations
Fargo, ND 58108-6747
Please address your fax cover sheet to the "DME LCD Reconsideration Administrator."
Requests shall be submitted in writing and shall identify the language that the requestor wants added or deleted from an LCD. Requests shall include a justification supported by new evidence that may materially affect the LCDs content or basis. Copies of published evidence shall be included.
The level of evidence required for LCD reconsideration is the same as that 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.
Noridian has the discretion to consolidate valid requests if similar requests are received.
Within 30 days of the day the request is received, Noridian shall determine whether the request is valid or invalid. If the request is invalid, Noridian shall respond, in writing, to the requestor explaining why the request was invalid. If the request is valid, the contractor should follow the requirements outlined below.
- Within 90 days of the day the valid request was received, the contractor shall make a final LCD reconsideration decision 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 to retire the LCD or to make no revision to the LCD, then within 90 days of receipt, Noridian 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.
Last Updated May 22, 2017