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Article for New Local Coverage Determination (LCD) Request Process (A56198)


Contractor Information

Contractor Name Contract Type Contract Number Jurisdiction State(s)
National Government Services, Inc. MAC - Part A 06101 - MAC A J - 06 Illinois
National Government Services, Inc. MAC - Part B 06102 - MAC B J - 06 Illinois
National Government Services, Inc. MAC - Part A 06201 - MAC A J - 06 Minnesota
National Government Services, Inc. MAC - Part B 06202 - MAC B J - 06 Minnesota
National Government Services, Inc. MAC - Part A 06301 - MAC A J - 06 Wisconsin
National Government Services, Inc. MAC - Part B 06302 - MAC B J - 06 Wisconsin
National Government Services, Inc. A and B and HHH MAC 13101 - MAC A J - K Connecticut
National Government Services, Inc. A and B and HHH MAC 13102 - MAC B J - K Connecticut
National Government Services, Inc. A and B and HHH MAC 13201 - MAC A J - K New York - Entire State
National Government Services, Inc. A and B and HHH MAC 13202 - MAC B J - K New York - Downstate
National Government Services, Inc. A and B and HHH MAC 13282 - MAC B J - K New York - Upstate
National Government Services, Inc. A and B and HHH MAC 13292 - MAC B J - K New York - Queens
National Government Services, Inc. A and B and HHH MAC 14111 - MAC A J - K Maine
National Government Services, Inc. A and B and HHH MAC 14112 - MAC B J - K Maine
National Government Services, Inc. A and B and HHH MAC 14211 - MAC A J - K Massachusetts
National Government Services, Inc. A and B and HHH MAC 14212 - MAC B J - K Massachusetts
National Government Services, Inc. A and B and HHH MAC 14311 - MAC A J - K New Hampshire
National Government Services, Inc. A and B and HHH MAC 14312 - MAC B J - K New Hampshire
National Government Services, Inc. A and B and HHH MAC 14411 - MAC A J - K Rhode Island
National Government Services, Inc. A and B and HHH MAC 14412 - MAC B J - K Rhode Island
National Government Services, Inc. A and B and HHH MAC 14511 - MAC A J - K Vermont
National Government Services, Inc. A and B and HHH MAC 14512 - MAC B J - K Vermont

Article Information

General Information

Article ID

A56198

Article Title

New Local Coverage Determination (LCD) Request Process

Original Article Effective Date

01/01/2019

Revision Effective Date

N/A

Revision Ending Date

N/A

Retirement Date

N/A

AMA CPT / ADA CDT / AHA NUBC Copyright Statement

CPT codes, descriptions and other data only are copyright 2017 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.

Current Dental Terminology © 2017 American Dental Association. All rights reserved.

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Article Guidance

Article Text:

The requirements in this article are based on instructions found in CMS Publication 100-08, Medicare Program Integrity Manual, Chapter 13, Section 13.2, 13.2.2.2, 13.2.2.3, and 13.2.1.1.

New LCD Request Process

The New LCD Request Process is a mechanism by which interested parties within a contractor’s jurisdiction can request a new LCD. New LCD requests will be considered from:

    • Beneficiaries residing or receiving care in a contractor’s jurisdiction;
    • Health care professionals doing business in a contractor’s jurisdiction; and
    • Any interested party doing business in a contractor’s jurisdiction.

The materials received will be reviewed within 60 calendar days from receipt and a determination will be made as to whether the request is complete or incomplete.

Valid Request Criteria

    • The request is in writing and can be sent to the MAC via e-mail, facsimile or written letter;
    • The request clearly identifies the statutorily-defined Medicare benefit category to which the requestor believes the item or service falls under and provides a rationale justifying the assignment;
    • The request shall identify the language that the requestor wants in an LCD;
    • The request shall include a justification supported by peer- reviewed evidence. Full copies of published evidence to be considered shall be included and failure to include same invalidates the request;
    • The request shall include information that addresses the relevance, usefulness, clinical health outcomes, or the medical benefits of the item or service; and
    • The request shall include information that fully explains the design, purpose, and/or method, as appropriate, of using the item or service for which the request is made.

If the request is valid, NGS will follow the LCD process as outlined in CMS Publication 100-08, Medicare Program Integrity Manual, Chapter 13, Section 13.2 or notify the requestor why the request is invalid.

Requests for Informal Meeting

    • Informal meetings may be held, so that interested parties in the MAC’s jurisdiction can informally discuss ONLY potential LCD requests.
    • The meetings are for educational purposes only and are not pre-decisional negotiations.
    • These meetings are permitted but are not required and the process allows requestors to communicate via conference call or in-person meeting before submitting a formal request for a new LCD.
    • These meetings will ensure that all relevant evidence needed for review for coverage is submitted with the request for a formal review.
    • Requests for development of a new LCD, or for informal meetings should be submitted to the e-mail address below.

Submission Methods

E-Mail

NGSnewlcdrequest@anthem.com

Fax

(317) 595-4334
Attention: New LCD Request

Mail

National Government Services, Inc.
Medical Policy Unit
Attention: New LCD Request
P.O. Box 7108
Indianapolis, IN 46207-7108


Coding Information

Bill Type Codes:

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

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Revenue Codes:

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.

N/A

CPT/HCPCS Codes

N/A

ICD-10 Codes that are Covered

ICD-10 Codes that are Not Covered

N/A


Revision History Information

Revision History Date Revision History Number Revision History Explanation
01/01/2019
R1
Article revised to correct the fax number.

Associated Documents

Related Local Coverage Document(s)

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Related National Coverage Document(s)

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Statutory Requirements URL(s)

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Rules and Regulations URL(s)

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CMS Manual Explanations URL(s)

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Other URL(s)

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Public Version(s)
Updated on 12/19/2018 with effective dates 01/01/2019 - N/A
Updated on 12/04/2018 with effective dates 01/01/2019 - N/A


Keywords

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Article for New Local Coverage Determination (LCD) Request Process (A56198)
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