The LCD Reconsideration Process is available only for final LCDs.  The whole LCD or any provision of the LCD may be reconsidered. Section 522 of  The Benefits Improvement and Protection Act (BIPA), created the term "local coverage determination" (LCD). 

TEXT:

Valid LCD Reconsideration Request Requirements:

1. LCD reconsideration requests will be considered from:
   Beneficiaries residing or receiving care in Highmark Medicare Services jurisdiction;
   Providers doing business in Highmark Medicare Services jurisdiction;
   Any interested party doing business in Highmark Medicare Services jurisdiction.
2. Highmark Medicare Services will only accept reconsideration requests for LCDs published in final form. Requests will not be accepted for other documents including:
   National Coverage Decisions (NCD);
   Coverage provisions in interpretive manuals;
   Draft LCDs;
   Template LCDs, unless or until they are adopted by Highmark Medicare Services;
   Retired LCDs;
   Individual claim determinations;
   Bulletins, articles, training materials; and
   Any instance in which no LCD exists, i.e., requests for development of an LCD. 
   
   If modification of the LCD would conflict with an NCD, the request is not valid.
   
   For these requests, Highmark Medicare Services suggests that the requestor review the NCD reconsideration process.  
3. Requests must be submitted in writing, and must identify the language that the requestor wants added to or deleted from an LCD.  Requests must include a justification   supported by new evidence, which may materially affect the LCD’s content or basis. Copies of published evidence must be included. 
   
   The level of evidence required for LCD reconsideration is the same as that required for new/revised LCD development. (Medicare Program Integrity Manual Pub. 100-8, Chapter 13, Section 7.1)
   
   There are several ways you can send Highmark Medicare Services your LCD Reconsideration requests:
   
   By U.S. Postal Service: 
   
   The Office of the Medical Director
   Attention: LCD Reconsideration Request
   Highmark Medicare Services
   1800 Center Street
   Camp Hill, PA 17089
   
   By email: andrew.bloschichak@highmark.com
   By Fax:   717-302-4165
4. Within 30 days of the day the request is received, Highmark Medicare Services will determine if the request is valid or invalid.  Any request for LCD reconsideration that, in the judgment of Highmark Medicare Services, does not meet the criteria described above, is invalid.  If the request is invalid, Highmark Medicare Services will respond, in writing, to the requestor explaining why the request was invalid.
5. If the request is valid:
   
   Within 90 days of the day the request was received, Highmark Medicare Services will make a final LCD reconsideration decision on the valid request and notify the requestor of the decision with Highmark Medicare Services rationale.  Decision options include retiring the policy, no revision, revision to a more restrictive policy, or revision to a less restrictive policy.

If the decision is to revise the LCD, Highmark Medicare Services will follow the normal process for LCD development .

Highmark Medicare Services will consolidate valid requests, if similar requests are received.       

REFERENCE:

The Centers for Medicare and Medicaid Services (CMS) Publication 100-08; Chapter 13, Section 13.11