New Local Coverage Determination (LCD) Request Process

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 **.**

**Health Disparities Analysis (Recommended)**

Requestors are strongly encouraged to include an analysis of any relevant
peer-reviewed medical literature that quantifies and/or describes any health
disparities related to the New LCD request, and how the requested change may
impact health disparities.

**_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](mailto: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