Medicare Program Integrity Manual

The Medicare Program Integrity Manual outlines that beneficiaries or healthcare professionals can request the coverage of items or services under specific Medicare benefit categories, provided they justify their requests according to established Local Coverage Determinations (LCDs) and National Coverage Determinations (NCDs). Key requirements include submitting requests with comprehensive evidence and rationale, while limitations specify that requests lacking peer-reviewed evidence will not be considered, and revisions to existing LCDs must reflect substantive changes. Additionally, consultation for evaluation and management services is covered, but all requests must adhere to defined procedures and timeframes.

"Requests are considered from beneficiaries, healthcare professionals, or any interested party within a contractor''s jurisdiction."

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