---
kind: "section"
citation: "42 C.F.R. § 426.465"
title: "42"
number: "426.465"
heading: "Appealing part or all of an ALJ's decision."
url: "https://uscodex.org/cfr/42/426.465"
---

# §426.465. Appealing part or all of an ALJ's decision.

- (a) **Circumstances under which an aggrieved party may appeal part or all of an ALJ's decision.** An aggrieved party (including one or more aggrieved parties named in a joint complaint and an aggrieved party who is part of a consolidated LCD review) may appeal to the Board any part of an ALJ's decision that does the following:
  - (1) States that a provision of an LCD is valid under the reasonableness standard; or
  - (2) **Dismisses a complaint regarding an LCD (except as prohibited in paragraph (b) of this section).**
- (b) **Circumstance under which a contractor or CMS may appeal part or all of an ALJ's decision.** A contractor or CMS may appeal to the Board any part of an ALJ's decision that states that a provision (or provisions) of an LCD is (are) unreasonable.
- (c) **Stay of an implementation pending appeal.**
  - (1) If an ALJ's decision finds a provision or provisions of an LCD unreasonable, an appeal by a contractor or CMS stays implementation as described under [§ 426.460(b)](/cfr/42/426.460.md?p=b) until the Board issues a final decision.
  - (2) The appeal request must be submitted to the Board in accordance with [paragraph (e)](#e) of this section.
- (d) **Circumstances under which an ALJ's decision may not be appealed.** An ALJ's decision dismissing a complaint is not subject to appeal in either of the following circumstances:
  - (1) **The contractor has retired the LCD provision(s) under review.**
  - (2) **The aggrieved party who filed the complaint has withdrawn the complaint.**
- (e) **Receipt of the appeal by the Board.** Unless there is good cause shown, an appeal described in paragraphs [(a)](#a) or [(b)](#b) of this section must be filed with the Board within 30 days of the date the ALJ's decision was issued.
- (f) **Filing an appeal.**
  - (1) To file an appeal described in [paragraph (a)](#a) of this section, an aggrieved party, who sought LCD review, a contractor, or CMS must send the following to the Board:
    - (i) **The full names and addresses of the parties, including the name of the LCD.**
    - (ii) **The date of issuance of the ALJ's decision.**
    - (iii) **The docket number that appears on the ALJ's decision.**
    - (iv) **A statement identifying the part(s) of the ALJ's decision that are being appealed.**
  - (2) If an appeal described in [paragraph (a)](#a) of this section is filed with the Board later than the date described in [paragraph (c)](#c) of this section, it must include a rationale stating why the Board must accept the late appeal.
  - (3) An appeal described in [paragraph (a)](#a) of this section must include a statement explaining why the ALJ's decision should be reversed.

## 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.