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CGS Associates, LLC

July 9, 2008 - Updated 08.04.16

LCD Reconsideration Process

The LCD (Local Coverage Determination) Reconsideration is a method by which interested parties can request a revision to an active LCD. The reconsideration process is available for final LCDs only. The entire LCD or any part of it is subject to reconsideration. NOTE: THIS IS NOT THE PROCESS FOR APPEALING AN INDIVIDUAL CLAIM. INFORMATION ON APPEALING AN INDIVIDUAL CLAIM MAY BE FOUND AT http://www.cgsmedicare.com/jc/claims/appeals/index.html.

The request must identify the language that the requestor wants added to or deleted from and LCD. Requests must include justification for the change supported by new evidence in the medical literature which will materially affect the LCDs content or basis. Legible hard-copies of published evidence must be included. CGS has the discretion to consolidate valid requests if similar requests are received. Any request for LCD reconsideration that, in the judgment of the contractor, does not meet these criteria is invalid.

CGS may revise or retire their LCDs at any time on their own initiatives.

CGS shall consider all LCD reconsideration requests from:

Reconsideration requests are only accepted for LCDs published in final form. Requests shall not be accepted for other documents including:

If modification of the final LCD would conflict with an NCD, the request will not be valid. For information about the NCD reconsideration process, reference https://www.cms.gov/Center/Special-Topic/Medicare-Coverage-Center.htmlExternal Website. Information about requesting an NCD or an NCD revision is found under "How to Request an NCD" in the Coverage Process section.

LCD reconsideration requests may be sent via e-mail (preferred) hard copy or facsimile. Electronic requests should be sent to LCDReconJC@cgsadmin.com with the name of the LCD and "LCD Reconsideration Request" in the subject line. If the attachment size for clinical citations exceeds 10 MB, the requestor must send the articles and supporting documents via CD or removable storage media (USB drive, etc.) to the address below for hard copies. Please note that this information is for DME MAC LCD reconsiderations. Information for submitting an LCD reconsideration request for the Jurisdiction 15 A/B MAC may be found at the J15 LCD Reconsideration Process page.

Requests submitted in hard copy may be sent to the following address:

CGS Administrators, LLC
Attn: Robert D. Hoover, Jr., MD, MPH
DME LCD Reconsiderations
Two Vantage Way
Nashville, TN 37228

Requests may also be faxed to 615.664.5955.
Please address your fax cover sheet to DME LCD Reconsideration - Attn: Dr. Robert Hoover.

NOTE: THE FAX NUMBER FOR APPEALING INDIVIDUAL CLAIMS (REDETERMINATIONS) IS 615.782.4630. THE FAX LINE 615.664.5955 IS FOR THE LCD RECONSIDERATION PROCESS DESCRIBED ABOVE.

Process

Within 30 days of the day the request is received, CGS will determine whether the request is valid or invalid. If the request is invalid, CGS will respond in writing to the requestor explaining why. If the request is valid, CGS will, within 90 days of the day the request was received, make a final LCD reconsideration decision and notify the requestor of the decision with its rationale. Decision options include retiring the LCD, no revision, and revision to a more restrictive or less restrictive LCD.

Related Information

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