In re LCD Complaint: B-Type Natriuretic Peptide (BNP) (L33573) (2025)

DECISION DISMSSING COMPLAINT  

In an acknowledgment dated November 4, 2024, the Civil Remedies Division of the Departmental Appeals Board acknowledged that it had received correspondence challenging the validity of a local coverage determination that addresses Medicare coverage for B-Type Natriuretic Peptide (BNP).  

In the November 4 acknowledgment, I explained that the regulations governing these proceedings do not allow me to accept an incomplete complaint and that I had determined that the complaint submitted did not meet the regulatory requirements.  42 C.F.R. §§ 426.400(c), 426.410(b)(1) and (2).  Pursuant to 42 C.F.R. § 426.410(c)(1), I offered the aggrieved party an opportunity to file an acceptable complaint and directed him to do so no later than December 4, 2024.  

I advised first that, based on the submissions, I had determined that the Medicare beneficiary, John Joseph Taylor, is an “aggrieved party” within the meaning of the regulation.  42 C.F.R. § 426.110.  

Second, I determined that the complaint was timely.  42 C.F.R. § 426.400(b)(1).  

However, I also determined that the complaint did not include all of the elements required by 42 C.F.R. § 426.400(c).  I advised the aggrieved party that his amended complaint should include the following information:  

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• LCD-identifying information, including the name of the LCD titled being challenged and the name of the Medicare contractor using the LCD.  42 C.F.R. § 426.400(c)(4).  
• An aggrieved party statement explaining why he thinks that the provisions of the LCDs are not valid under a reasonableness standard.  42 C.F.R. § 426.400(c)(5).  
• Clinical or scientific evidence that supports the complaint, along with an explanation as to why this evidence shows that the LCD is not reasonable.  42 C.F.R. § 426.400(c)(6).  

Petitioner did not file an amended complaint.  Because Petitioner has not, within the timeframe established, submitted an acceptable amended complaint, I dismiss this action pursuant to 42 C.F.R. § 426.410(c)(2).