US · guidance
CMS Pub. 100-08, ch. 3, § 3.3.3
Reviewing Claims in the Absence of Policies and Guidelines
The MACs, CERT, Recovery Auditors, and UPICs have the discretion to review claims,
in the absence of polices, whether a NCD, coverage provision in an interpretive Medicare
manual, or LCD exists for that service. When making individual claim determinations,
they shall determine that the service in question is covered based on whether the service
meets all of the conditions listed in section 3.6.2.1.
History
(Rev. 10365; Issued: 10-02-20; Effective: 08-27-20; Implementation: 08-27-20)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
1f34da222666f6744eb58a27a5287de7323eb424b447fc3874e0bb6b942a84f0
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