42 CFR §426.325
Verified against eCFR.gov as of June 20, 2026View official text on eCFR.gov ↗
- (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—
- (2)Retired LCDs or withdrawn NCDs.
- (3)LCD or NCD provisions that are no longer in effect due to revisions or reconsiderations.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.