CorporateBusiness Services

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.

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:

  • Beneficiaries residing or receiving care in our contractor's jurisdiction; and
  • Providers doing business in our contractor's jurisdiction.
  • Any interested party doing business in our contractor's jurisdiction

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

  • National coverage Decisions (NCD);
  • 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 final LCD would conflict with an NCD, the request will not be valid. For information about the NCD reconsideration process, reference ttps://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.

Reconsideration requests can be sent for review via one of the following methods:

  • Preferred Method - email: CMD.Inquiry@cgsadmin.com
  • Fax: 615.664.5971
  • Mail:

    CGS Administrators
    Attn: Chief Medical Director
    J15 A/B MAC LCD Reconsideration
    Two Vantage Way
    Nashville, Tennessee 37228

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 policy, no revision, and revision to a more restrictive or less restrictive LCD.

Updated 02.17.16


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