---
kind: "section"
citation: "42 C.F.R. § 426.431"
title: "42"
number: "426.431"
heading: "ALJ's review of the LCD to apply the reasonableness standard."
url: "https://uscodex.org/cfr/42/426.431"
---

# §426.431. ALJ's review of the LCD to apply the reasonableness standard.

- (a) **Required steps.** To review the provision(s) listed in the aggrieved party's complaint based on the reasonableness standard, an ALJ must:
  - (1) **Confine the LCD review to the provision(s) of the LCD raised in the aggrieved party's complaint.**
  - (2) **Conduct a hearing, unless the matter can be decided on the written record.**
  - (3) **Close the LCD review record to the taking of evidence.**
  - (4) Treat as precedential any previous Board decision under [§ 426.482](/cfr/42/426.482.md) that involves the same LCD provison(s), same specific issue and facts in question, and the same clinical conditions.
  - (5) Issue a decision as described in [§ 426.447](/cfr/42/426.447.md).
- (b) **Optional steps.** The ALJ may do the following to apply the reasonableness standard to the provision(s) listed in the aggrieved party's complaint:
  - (1) **Consult with appropriate scientific or clinical experts concerning evidence.**
  - (2) Consider any previous ALJ decision made under [§ 426.447](/cfr/42/426.447.md) regarding the same provision(s) of the LCD under review and for the same clinical conditions.
- (c) **Authority for ALJs in LCD reviews when applying the reasonableness standard.** In applying the reasonableness standard to a provision (or provisions) of an LCD, the ALJ must follow all applicable laws, regulations, rulings, and NCDs.

## Notes

### Authority

Authority: Secs. 1102 and 1871 of the Social Security Act (42 U.S.C. 1302 and 1395hh)

### Source

Source: 68 FR 63716, Nov. 7, 2003, unless otherwise noted.