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. § 426.310

LCD and NCD reviews and individual claim appeals

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(a) LCD and NCD reviews are distinct from the claims appeal processes set forth in part 405, subparts G and H; part 417, subpart Q; and part 422, subpart M of this chapter.

(b) An aggrieved party must notify the ALJ or the Board, as appropriate, regarding the submission and disposition of any pending claim or appeal relating to the subject of the aggrieved party's LCD or NCD complaint. This reporting obligation continues through the entire LCD or NCD review process.

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 “12 12 An LCD challenge is “distinct from the claims appeal processes,” 42 C.F.R. § 426.310 , and cannot be used to review “an individual claim determination,” id.”
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