I dismiss the hearing request filed by the aggrieved party. I do so because the Local Coverage Determination (LCD) that she challenged has now been revised retroactively to cover the claim for Medicare reimbursement that was the basis for her hearing request. I am required to dismiss a hearing request challenging an LCD where a revision provides coverage for a procedure that was previously not covered and where the aggrieved party’s claim is now covered under the revised LCD.

The aggrieved party filed a hearing request pursuant to 42 C.F.R. Part 426 to challenge an LCD made by Wisconsin Physician Services (WPS). That LCD had been applied to deny the aggrieved party’s October 3, 2005 claim for Medicare reimbursement for a procedure that had been performed on September 9, 2005. The procedure consisted of a magnetic resonance imaging scan of the aggrieved party’s pelvis to rule out the presence of pelvic lymph node and sacral metastasis secondary to adenocarcinoma of the breast. The aggrieved party’s claim for reimbursement was denied initially and on reconsideration based on the provisions of the LCD.

The aggrieved party’s case was assigned to me for a hearing and a decision. On May 9, 2006, I received a letter from WPS on the letterhead of the Centers for Medicare & Medicaid Services advising me that the LCD had been revised to include the two diagnostic codes that the aggrieved party had challenged in her hearing request. WPS stated specifically that the revised LCD would provide coverage for lumbosacral plexus lesions and magnetic resonance imaging of the abdomen and pelvis.

On May 31, 2006, I wrote to WPS asking for a clarification of its May 9 letter. I asked it whether the revised LCD would cover the aggrieved party’s September 9, 2005 procedure and her October 3, 2005 reimbursement request. On June 9, 2006, WPS sent me a letter in which it assured me that the LCD revision was made retroactive to January 1, 2005. Consequently, the revision covered the date of the aggrieved party’s procedure.

On June 20, 2006, I wrote to the aggrieved party advising her that I was prepared to dismiss her hearing request because her procedure and reimbursement claim were now covered by the revised LCD. I gave the aggrieved party an opportunity to file comments or objections. The aggrieved party did not do so.

This case is governed by regulations that are at 42 C.F.R. Part 426. At 42 C.F.R. § 426.444(b)(6), the regulations require that I dismiss a hearing request challenging an LCD where a revision provides coverage for a procedure that was previously not covered and where the aggrieved party’s claim is now covered under the revised LCD. The aggrieved party’s claim was not previously covered by the LCD but now is covered. WPS has stated explicitly that the revised LCD will apply retroactively to cover the aggrieved party’s procedure and claim. Consequently, the aggrieved party no longer has a basis for a hearing and I must dismiss her hearing request.