---
kind: "section"
citation: "42 C.F.R. § 426.531"
title: "42"
number: "426.531"
heading: "Board's review of the NCD to apply the reasonableness standard."
url: "https://uscodex.org/cfr/42/426.531"
---

# §426.531. Board's review of the NCD to apply the reasonableness standard.

- (a) **Required steps.** The Board must do the following to review the provision(s) listed in the aggrieved party's complaint based on the reasonableness standard:
  - (1) **Confine the NCD review to the provision(s) of the NCD raised in the aggrieved party's complaint.**
  - (2) **Conduct a hearing unless the matter can be decided on the written record.**
  - (3) **Close the NCD review record to the taking of evidence.**
  - (4) Treat as precedential any previous Board decision made under [§ 426.547](/cfr/42/426.547.md) that involves the same NCD provision(s), same specific issue and facts in question, and the same clinical conditions.
  - (5) Issue a decision as described in [§ 426.547](/cfr/42/426.547.md).
- (b) **Optional steps.** The Board may consult with appropriate scientific or clinical experts concerning clinical and scientific evidence to apply the reasonableness standard to the provision(s) listed in the aggrieved party's complaint.
- (c) **Authority for the Board in NCD reviews when applying the reasonableness standard.** In applying the reasonableness standard to a provision (or provisions) of an NCD, the Board must follow all applicable laws and regulations, as well as NCDs other than the one under review.

## 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.