Title 42

PART 426

Part 426 - Review Of National Coverage Determinations And Local Coverage Determinations

PART 426 - REVIEW OF NATIONAL COVERAGE DETERMINATIONS AND LOCAL COVERAGE DETERMINATIONS Authority:Secs. 1102 and 1871 of the Social Security Act (42 U.S.C. 1302 and 1395hh) Source:68 FR 63716, Nov. 7, 2003, unless otherwise noted.

• Authority: Secs. 1102 and 1871 of the Social Security Act (42 U.S.C. 1302 and 1395hh)
• Source: 68 FR 63716, Nov. 7, 2003, unless otherwise noted.

42:3.0.1.1.13.1	SUBPART A	Subpart A - General Provisions
42:3.0.1.1.13.1.11.1	SECTION 426.100	426.100 Basis and scope.
42:3.0.1.1.13.1.11.2	SECTION 426.110	426.110 Definitions.
42:3.0.1.1.13.1.11.3	SECTION 426.120	426.120 Calculation of deadlines.
42:3.0.1.1.13.1.11.4	SECTION 426.130	426.130 Party submissions.
42:3.0.1.1.13.2	SUBPART B	Subpart B [Reserved]
42:3.0.1.1.13.3	SUBPART C	Subpart C - General Provisions for the Review of LCDs and NCDs
42:3.0.1.1.13.3.11.1	SECTION 426.300	426.300 Review of LCDs, NCDs, and deemed NCDs.
42:3.0.1.1.13.3.11.2	SECTION 426.310	426.310 LCD and NCD reviews and individual claim appeals.
42:3.0.1.1.13.3.11.3	SECTION 426.320	426.320 Who may challenge an LCD or NCD.
42:3.0.1.1.13.3.11.4	SECTION 426.325	426.325 What may be challenged.
42:3.0.1.1.13.3.11.5	SECTION 426.330	426.330 Burden of proof.
42:3.0.1.1.13.3.11.6	SECTION 426.340	426.340 Procedures for review of new evidence.
42:3.0.1.1.13.4	SUBPART D	Subpart D - Review of an LCD
42:3.0.1.1.13.4.11.1	SECTION 426.400	426.400 Procedure for filing an acceptable complaint concerning a provision (or provisions) of an LCD.
42:3.0.1.1.13.4.11.2	SECTION 426.403	426.403 Submitting new evidence once an acceptable complaint is filed.
42:3.0.1.1.13.4.11.3	SECTION 426.405	426.405 Authority of the ALJ.
42:3.0.1.1.13.4.11.4	SECTION 426.406	426.406 Ex parte contacts.
42:3.0.1.1.13.4.11.5	SECTION 426.410	426.410 Docketing and evaluating the acceptability of LCD complaints.
42:3.0.1.1.13.4.11.6	SECTION 426.415	426.415 CMS' role in the LCD review.
42:3.0.1.1.13.4.11.7	SECTION 426.416	426.416 Role of Medicare Managed Care Organizations (MCOs) and State agencies in the LCD review.
42:3.0.1.1.13.4.11.8	SECTION 426.417	426.417 Contractor's statement regarding new evidence.
42:3.0.1.1.13.4.11.9	SECTION 426.418	426.418 LCD record furnished to aggrieved party.
42:3.0.1.1.13.4.11.10	SECTION 426.419	426.419 LCD record furnished to the ALJ.
42:3.0.1.1.13.4.11.11	SECTION 426.420	426.420 Retiring or revising an LCD under review.
42:3.0.1.1.13.4.11.12	SECTION 426.423	426.423 Withdrawing a complaint regarding an LCD under review.
42:3.0.1.1.13.4.11.13	SECTION 426.425	426.425 LCD review.
42:3.0.1.1.13.4.11.14	SECTION 426.431	426.431 ALJ's review of the LCD to apply the reasonableness standard.
42:3.0.1.1.13.4.11.15	SECTION 426.432	426.432 Discovery.
42:3.0.1.1.13.4.11.16	SECTION 426.435	426.435 Subpoenas.
42:3.0.1.1.13.4.11.17	SECTION 426.440	426.440 Evidence.
42:3.0.1.1.13.4.11.18	SECTION 426.444	426.444 Dismissals for cause.
42:3.0.1.1.13.4.11.19	SECTION 426.445	426.445 Witness fees.
42:3.0.1.1.13.4.11.20	SECTION 426.446	426.446 Record of hearing.
42:3.0.1.1.13.4.11.21	SECTION 426.447	426.447 Issuance and notification of an ALJ's decision.
42:3.0.1.1.13.4.11.22	SECTION 426.450	426.450 Mandatory provisions of an ALJ's decision.
42:3.0.1.1.13.4.11.23	SECTION 426.455	426.455 Prohibited provisions of an ALJ's decision.
42:3.0.1.1.13.4.11.24	SECTION 426.457	426.457 Optional provisions of an ALJ's decision.
42:3.0.1.1.13.4.11.25	SECTION 426.458	426.458 ALJ's LCD review record.
42:3.0.1.1.13.4.11.26	SECTION 426.460	426.460 Effect of an ALJ's decision.
42:3.0.1.1.13.4.11.27	SECTION 426.462	426.462 Notice of an ALJ's decision.
42:3.0.1.1.13.4.11.28	SECTION 426.463	426.463 Future new or revised LCDs.
42:3.0.1.1.13.4.11.29	SECTION 426.465	426.465 Appealing part or all of an ALJ's decision.
42:3.0.1.1.13.4.11.30	SECTION 426.468	426.468 Decision to not appeal an ALJ's decision.
42:3.0.1.1.13.4.11.31	SECTION 426.470	426.470 Board's role in docketing and evaluating the acceptability of appeals of ALJ decisions.
42:3.0.1.1.13.4.11.32	SECTION 426.476	426.476 Board review of an ALJ's decision.
42:3.0.1.1.13.4.11.33	SECTION 426.478	426.478 Retiring or revising an LCD during the Board's review of an ALJ's decision.
42:3.0.1.1.13.4.11.34	SECTION 426.480	426.480 Withdrawing an appeal of an ALJ's decision.
42:3.0.1.1.13.4.11.35	SECTION 426.482	426.482 Issuance and notification of a Board decision.
42:3.0.1.1.13.4.11.36	SECTION 426.484	426.484 Mandatory provisions of a Board decision.
42:3.0.1.1.13.4.11.37	SECTION 426.486	426.486 Prohibited provisions of a Board decision.
42:3.0.1.1.13.4.11.38	SECTION 426.487	426.487 Board's record on appeal of an ALJ's decision.
42:3.0.1.1.13.4.11.39	SECTION 426.488	426.488 Effect of a Board decision.
42:3.0.1.1.13.4.11.40	SECTION 426.489	426.489 Board remands.
42:3.0.1.1.13.4.11.41	SECTION 426.490	426.490 Board decision.
42:3.0.1.1.13.5	SUBPART E	Subpart E - Review of an NCD
42:3.0.1.1.13.5.11.1	SECTION 426.500	426.500 Procedure for filing an acceptable complaint concerning a provision (or provisions) of an NCD.
42:3.0.1.1.13.5.11.2	SECTION 426.503	426.503 Submitting new evidence once an acceptable complaint has been filed.
42:3.0.1.1.13.5.11.3	SECTION 426.505	426.505 Authority of the Board.
42:3.0.1.1.13.5.11.4	SECTION 426.506	426.506 Ex parte contacts.
42:3.0.1.1.13.5.11.5	SECTION 426.510	426.510 Docketing and evaluating the acceptability of NCD complaints.
42:3.0.1.1.13.5.11.6	SECTION 426.513	426.513 Participation as amicus curiae.
42:3.0.1.1.13.5.11.7	SECTION 426.515	426.515 CMS' role in making the NCD record available.
42:3.0.1.1.13.5.11.8	SECTION 426.516	426.516 Role of Medicare Managed Care Organizations (MCOs) and State agencies in the NCD review process.
42:3.0.1.1.13.5.11.9	SECTION 426.517	426.517 CMS' statement regarding new evidence.
42:3.0.1.1.13.5.11.10	SECTION 426.518	426.518 NCD record furnished to the aggrieved party.
42:3.0.1.1.13.5.11.11	SECTION 426.519	426.519 NCD record furnished to the Board.
42:3.0.1.1.13.5.11.12	SECTION 426.520	426.520 Withdrawing an NCD under review or issuing a revised or reconsidered NCD.
42:3.0.1.1.13.5.11.13	SECTION 426.523	426.523 Withdrawing a complaint regarding an NCD under review.
42:3.0.1.1.13.5.11.14	SECTION 426.525	426.525 NCD review.
42:3.0.1.1.13.5.11.15	SECTION 426.531	426.531 Board's review of the NCD to apply the reasonableness standard.
42:3.0.1.1.13.5.11.16	SECTION 426.532	426.532 Discovery.
42:3.0.1.1.13.5.11.17	SECTION 426.535	426.535 Subpoenas.
42:3.0.1.1.13.5.11.18	SECTION 426.540	426.540 Evidence.
42:3.0.1.1.13.5.11.19	SECTION 426.544	426.544 Dismissals for cause.
42:3.0.1.1.13.5.11.20	SECTION 426.545	426.545 Witness fees.
42:3.0.1.1.13.5.11.21	SECTION 426.546	426.546 Record of hearing.
42:3.0.1.1.13.5.11.22	SECTION 426.547	426.547 Issuance, notification, and posting of a Board's decision.
42:3.0.1.1.13.5.11.23	SECTION 426.550	426.550 Mandatory provisions of the Board's decision.
42:3.0.1.1.13.5.11.24	SECTION 426.555	426.555 Prohibited provisions of the Board's decision.
42:3.0.1.1.13.5.11.25	SECTION 426.557	426.557 Optional provisions of the Board's decision.
42:3.0.1.1.13.5.11.26	SECTION 426.560	426.560 Effect of the Board's decision.
42:3.0.1.1.13.5.11.27	SECTION 426.562	426.562 Notice of the Board's decision.
42:3.0.1.1.13.5.11.28	SECTION 426.563	426.563 Future new or revised or reconsidered NCDs.
42:3.0.1.1.13.5.11.29	SECTION 426.565	426.565 Board's role in making an LCD or NCD review record available.
42:3.0.1.1.13.5.11.30	SECTION 426.566	426.566 Board decision.
42:3.0.1.1.13.5.11.31	SECTION 426.587	426.587 Record for appeal of a Board NCD decision.

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