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.

42:3.0.1.1.13.1SUBPART A
Subpart A - General Provisions
42:3.0.1.1.13.1.9.1SECTION 426.100
   426.100 Basis and scope.
42:3.0.1.1.13.1.9.2SECTION 426.110
   426.110 Definitions.
42:3.0.1.1.13.1.9.3SECTION 426.120
   426.120 Calculation of deadlines.
42:3.0.1.1.13.1.9.4SECTION 426.130
   426.130 Party submissions.
42:3.0.1.1.13.2SUBPART B
Subpart B [Reserved]
42:3.0.1.1.13.3SUBPART C
Subpart C - General Provisions for the Review of LCDs and NCDs
42:3.0.1.1.13.3.9.1SECTION 426.300
   426.300 Review of LCDs, NCDs, and deemed NCDs.
42:3.0.1.1.13.3.9.2SECTION 426.310
   426.310 LCD and NCD reviews and individual claim appeals.
42:3.0.1.1.13.3.9.3SECTION 426.320
   426.320 Who may challenge an LCD or NCD.
42:3.0.1.1.13.3.9.4SECTION 426.325
   426.325 What may be challenged.
42:3.0.1.1.13.3.9.5SECTION 426.330
   426.330 Burden of proof.
42:3.0.1.1.13.3.9.6SECTION 426.340
   426.340 Procedures for review of new evidence.
42:3.0.1.1.13.4SUBPART D
Subpart D - Review of an LCD
42:3.0.1.1.13.4.9.1SECTION 426.400
   426.400 Procedure for filing an acceptable complaint concerning a provision (or provisions) of an LCD.
42:3.0.1.1.13.4.9.2SECTION 426.403
   426.403 Submitting new evidence once an acceptable complaint is filed.
42:3.0.1.1.13.4.9.3SECTION 426.405
   426.405 Authority of the ALJ.
42:3.0.1.1.13.4.9.4SECTION 426.406
   426.406 Ex parte contacts.
42:3.0.1.1.13.4.9.5SECTION 426.410
   426.410 Docketing and evaluating the acceptability of LCD complaints.
42:3.0.1.1.13.4.9.6SECTION 426.415
   426.415 CMS' role in the LCD review.
42:3.0.1.1.13.4.9.7SECTION 426.416
   426.416 Role of Medicare Managed Care Organizations (MCOs) and State agencies in the LCD review.
42:3.0.1.1.13.4.9.8SECTION 426.417
   426.417 Contractor's statement regarding new evidence.
42:3.0.1.1.13.4.9.9SECTION 426.418
   426.418 LCD record furnished to aggrieved party.
42:3.0.1.1.13.4.9.10SECTION 426.419
   426.419 LCD record furnished to the ALJ.
42:3.0.1.1.13.4.9.11SECTION 426.420
   426.420 Retiring or revising an LCD under review.
42:3.0.1.1.13.4.9.12SECTION 426.423
   426.423 Withdrawing a complaint regarding an LCD under review.
42:3.0.1.1.13.4.9.13SECTION 426.425
   426.425 LCD review.
42:3.0.1.1.13.4.9.14SECTION 426.431
   426.431 ALJ's review of the LCD to apply the reasonableness standard.
42:3.0.1.1.13.4.9.15SECTION 426.432
   426.432 Discovery.
42:3.0.1.1.13.4.9.16SECTION 426.435
   426.435 Subpoenas.
42:3.0.1.1.13.4.9.17SECTION 426.440
   426.440 Evidence.
42:3.0.1.1.13.4.9.18SECTION 426.444
   426.444 Dismissals for cause.
42:3.0.1.1.13.4.9.19SECTION 426.445
   426.445 Witness fees.
42:3.0.1.1.13.4.9.20SECTION 426.446
   426.446 Record of hearing.
42:3.0.1.1.13.4.9.21SECTION 426.447
   426.447 Issuance and notification of an ALJ's decision.
42:3.0.1.1.13.4.9.22SECTION 426.450
   426.450 Mandatory provisions of an ALJ's decision.
42:3.0.1.1.13.4.9.23SECTION 426.455
   426.455 Prohibited provisions of an ALJ's decision.
42:3.0.1.1.13.4.9.24SECTION 426.457
   426.457 Optional provisions of an ALJ's decision.
42:3.0.1.1.13.4.9.25SECTION 426.458
   426.458 ALJ's LCD review record.
42:3.0.1.1.13.4.9.26SECTION 426.460
   426.460 Effect of an ALJ's decision.
42:3.0.1.1.13.4.9.27SECTION 426.462
   426.462 Notice of an ALJ's decision.
42:3.0.1.1.13.4.9.28SECTION 426.463
   426.463 Future new or revised LCDs.
42:3.0.1.1.13.4.9.29SECTION 426.465
   426.465 Appealing part or all of an ALJ's decision.
42:3.0.1.1.13.4.9.30SECTION 426.468
   426.468 Decision to not appeal an ALJ's decision.
42:3.0.1.1.13.4.9.31SECTION 426.470
   426.470 Board's role in docketing and evaluating the acceptability of appeals of ALJ decisions.
42:3.0.1.1.13.4.9.32SECTION 426.476
   426.476 Board review of an ALJ's decision.
42:3.0.1.1.13.4.9.33SECTION 426.478
   426.478 Retiring or revising an LCD during the Board's review of an ALJ's decision.
42:3.0.1.1.13.4.9.34SECTION 426.480
   426.480 Withdrawing an appeal of an ALJ's decision.
42:3.0.1.1.13.4.9.35SECTION 426.482
   426.482 Issuance and notification of a Board decision.
42:3.0.1.1.13.4.9.36SECTION 426.484
   426.484 Mandatory provisions of a Board decision.
42:3.0.1.1.13.4.9.37SECTION 426.486
   426.486 Prohibited provisions of a Board decision.
42:3.0.1.1.13.4.9.38SECTION 426.487
   426.487 Board's record on appeal of an ALJ's decision.
42:3.0.1.1.13.4.9.39SECTION 426.488
   426.488 Effect of a Board decision.
42:3.0.1.1.13.4.9.40SECTION 426.489
   426.489 Board remands.
42:3.0.1.1.13.4.9.41SECTION 426.490
   426.490 Board decision.
42:3.0.1.1.13.5SUBPART E
Subpart E - Review of an NCD
42:3.0.1.1.13.5.9.1SECTION 426.500
   426.500 Procedure for filing an acceptable complaint concerning a provision (or provisions) of an NCD.
42:3.0.1.1.13.5.9.2SECTION 426.503
   426.503 Submitting new evidence once an acceptable complaint has been filed.
42:3.0.1.1.13.5.9.3SECTION 426.505
   426.505 Authority of the Board.
42:3.0.1.1.13.5.9.4SECTION 426.506
   426.506 Ex parte contacts.
42:3.0.1.1.13.5.9.5SECTION 426.510
   426.510 Docketing and evaluating the acceptability of NCD complaints.
42:3.0.1.1.13.5.9.6SECTION 426.513
   426.513 Participation as amicus curiae.
42:3.0.1.1.13.5.9.7SECTION 426.515
   426.515 CMS' role in making the NCD record available.
42:3.0.1.1.13.5.9.8SECTION 426.516
   426.516 Role of Medicare Managed Care Organizations (MCOs) and State agencies in the NCD review process.
42:3.0.1.1.13.5.9.9SECTION 426.517
   426.517 CMS' statement regarding new evidence.
42:3.0.1.1.13.5.9.10SECTION 426.518
   426.518 NCD record furnished to the aggrieved party.
42:3.0.1.1.13.5.9.11SECTION 426.519
   426.519 NCD record furnished to the Board.
42:3.0.1.1.13.5.9.12SECTION 426.520
   426.520 Withdrawing an NCD under review or issuing a revised or reconsidered NCD.
42:3.0.1.1.13.5.9.13SECTION 426.523
   426.523 Withdrawing a complaint regarding an NCD under review.
42:3.0.1.1.13.5.9.14SECTION 426.525
   426.525 NCD review.
42:3.0.1.1.13.5.9.15SECTION 426.531
   426.531 Board's review of the NCD to apply the reasonableness standard.
42:3.0.1.1.13.5.9.16SECTION 426.532
   426.532 Discovery.
42:3.0.1.1.13.5.9.17SECTION 426.535
   426.535 Subpoenas.
42:3.0.1.1.13.5.9.18SECTION 426.540
   426.540 Evidence.
42:3.0.1.1.13.5.9.19SECTION 426.544
   426.544 Dismissals for cause.
42:3.0.1.1.13.5.9.20SECTION 426.545
   426.545 Witness fees.
42:3.0.1.1.13.5.9.21SECTION 426.546
   426.546 Record of hearing.
42:3.0.1.1.13.5.9.22SECTION 426.547
   426.547 Issuance, notification, and posting of a Board's decision.
42:3.0.1.1.13.5.9.23SECTION 426.550
   426.550 Mandatory provisions of the Board's decision.
42:3.0.1.1.13.5.9.24SECTION 426.555
   426.555 Prohibited provisions of the Board's decision.
42:3.0.1.1.13.5.9.25SECTION 426.557
   426.557 Optional provisions of the Board's decision.
42:3.0.1.1.13.5.9.26SECTION 426.560
   426.560 Effect of the Board's decision.
42:3.0.1.1.13.5.9.27SECTION 426.562
   426.562 Notice of the Board's decision.
42:3.0.1.1.13.5.9.28SECTION 426.563
   426.563 Future new or revised or reconsidered NCDs.
42:3.0.1.1.13.5.9.29SECTION 426.565
   426.565 Board's role in making an LCD or NCD review record available.
42:3.0.1.1.13.5.9.30SECTION 426.566
   426.566 Board decision.
42:3.0.1.1.13.5.9.31SECTION 426.587
   426.587 Record for appeal of a Board NCD decision.