Wiki Can Medicare denials for LCD be appealed?

[CatchTheWind]

If a Medicare LCD says a procedure is deemed to be medically necessary only for a certain diagnosis, and the provider performs it for a different diagnosis, can this be appealed if you can show that literature justifies it? Or are LCDs "written in stone" and no other diagnosis will be considered?

 

[mitchellde]

Yes it can be appealed. You will need some type of current literature to show that it is an acceptable service for the diagnosis given new thoughts and developments. If they agree, you will be granted an exception.

 

[CatchTheWind]

Thanks a lot, Debra!