The "Local coverage determination (LCD) reconsideration process" is a process by which interested parties can request a revision to a Florida Part B Medicare LCD. First Coast Service Options Inc. (FCSO), the Florida Medicare carrier, will gladly consider all requests for LCD reconsideration received from Medicare beneficiaries who reside (or receive care) in Florida or from providers who do business in Florida. Additionally, Florida Medicare Part B will review requests received from other interested parties and, at its discretion, reconsider LCDs based on such requests.

Individuals utilizing the LCD reconsideration process can request that the carrier modify any section of an existing LCD. Generally, requests for policy modification will involve requests that information be added to an LCD or that information be deleted from an LCD. For example, one might request that changes be made to the "Indications and Limitations" section of an LCD, or one might request that additional diagnoses be added to the "Diagnoses that Support Medical Necessity" section of an LCD.

All LCD reconsideration requests must be submitted in writing and must clearly state the specific revisions/modifications that the requestor is seeking. Requests must include a justification supported by evidence, which may materially affect the LCD content or basis. Copies of published evidence (e.g., peer-reviewed medical literature, published studies, etc.) must be included with the revision request.

Once the carrier receives a written request for LCD reconsideration, the carrier will, within 30 days, determine if the request is valid (i.e., satisfies the requirements outlined above). If the request is invalid, Florida Medicare Part B will respond in writing to the requestor explaining why the request was invalid. If the request is valid, Florida Medicare Part B will, within 90 days of the day the request was received, make a final LCD reconsideration decision and notify the requestor of the decision along with the rationale for the decision. Decisions made by Florida Medicare Part B might include one of the following:

If the decision is either to retire the LCD, or to make no revision to the LCD, then within 90 days of the day the request was received, Florida Medicare Part B will inform the requestor of its decision and the rationale for the decision. If the decision is to revise the LCD, the normal process for LCD development will be followed.

Requests for LCD reconsideration should be sent to the following address, fax, or e-mail:

Please note that the LCD reconsideration process applies only to finalized, active, Florida Medicare Part B LCDs. These LCDs are posted on the Florida carrier’s Web site at http://www.floridamedicare.com/Part_B/Local_Medical_Coverage/Final_LCDs/index.asp. The "LCD reconsideration process" does not apply to the following:

Information concerning the process for requesting modification of a National Coverage Decision can be found at http://www.cms.hhs.gov/DeterminationProcess/01_Overview.asp .