Medicare Program Integrity Manual, Chapter 13

The Medicare Program Integrity Manual, Chapter 13, allows beneficiaries and healthcare professionals to request new Local Coverage Determinations (LCDs) or reconsider existing ones, provided they include justification supported by new evidence. Coverage is available for items or services deemed safe, effective, and clinically useful for the target Medicare population, with the stipulation that requests must adhere to formal submission requirements and cannot contradict National Coverage Determinations (NCDs). There are no specific limitations on coverage, but requests unrelated to formally published final LCDs or that fail to meet documentation requirements will not be accepted.

"Requests for new LCDs can be submitted by beneficiaries, healthcare professionals, or any interested parties within the contractor''s jurisdiction."

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