42 CFR 426.325 : Public Health (Part 1 To Parts 1009-1099) — (§ 414.1 To Parts 427-429) — Centers For Medicare & Medicaid Services, Department Of Health And Human Services (Continued) (§ 414.1 To Parts 427-429) — Medicare Program (Continued) (§ 414.1 To Parts 427-429) — Review Of National Coverage Determinations And Local Coverage Determinations (§ 426.100 To § 426.587) — General Provisions For The Review Of Lcds And Ncds (§ 426.300 To § 426.340) — What may be challenged.

(a) Only LCDs or NCDs (including deemed NCDs) that are currently effective may be challenged.

(b) Some items are not reviewable under this part, including the following:

(1) Pre-decisional materials, including -

(i) Draft LCDs;

(ii) Template LCDs or suggested LCDs; and

(iii) Draft NCDs, including national coverage decision memoranda.

(2) Retired LCDs or withdrawn NCDs.

(3) LCD or NCD provisions that are no longer in effect due to revisions or reconsiderations.

(4) Interpretive policies that are not an LCD or NCD.

(5) Contractor decisions that are not based on section 1862(a)(1)(A) of the Act.

(6) Contractor claims processing edits.

(7) Payment amounts or methodologies.

(8) Procedure coding issues, including determinations, methodologies, definitions, or provisions.

(9) Contractor bulletin articles, educational materials, or Web site frequently asked questions.

(10) Any M + C organization or managed care plan policy, rule, or procedure.

(11) An individual claim determination.

(12) Any other policy that is not an LCD or an NCD as set forth in § 400.202 of this chapter.