C.F.R. » Title 42 » CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES › SUBCHAPTER B—MEDICARE PROGRAM › PART 426—REVIEW OF NATIONAL COVERAGE DETERMINATIONS AND LOCAL COVERAGE DETERMINATIONS › Subpart C—General Provisions for the Review of LCDs and NCDs

42 C.F.R. § 426.300

Review of LCDs, NCDs, and deemed NCDs

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(a) Upon the receipt of an acceptable LCD complaint as described in § 426.400, an ALJ conducts a review of a challenged provision (or provisions) of an LCD using the reasonableness standard.

(b) Upon the receipt of an acceptable NCD complaint as described in § 426.500, the Board conducts an NCD review of a challenged provision (or provisions) of an NCD using the reasonableness standard.

(c) The procedures established in this part governing the review of NCDs also apply in cases in which a deemed NCD is challenged.

Notes of Decisions
Cited in 1 case, 2019–2019 · leading case: Arturo Porzecanski v. Alex Azar
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Arturo Porzecanski v. Alex Azar (2019) cadc “§ 1395ff(f)(2)(A)(iv), including, in some cases, “without otherwise exhausting other administrative remedies,” id. § 1395ff(f)(3).”
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