42 CFR § 426.455 - Prohibited provisions of an ALJ's decision.

---
identifier: "/us/cfr/t42/s426.455"
source: "ecfr"
legal_status: "authoritative_unofficial"
title: "42 CFR § 426.455 - Prohibited provisions of an ALJ's decision."
title_number: 42
title_name: "Public Health"
section_number: "426.455"
section_name: "Prohibited provisions of an ALJ's decision."
chapter_name: "CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES"
subchapter_number: "B"
subchapter_name: "MEDICARE PROGRAM"
part_number: "426"
part_name: "REVIEW OF NATIONAL COVERAGE DETERMINATIONS AND LOCAL COVERAGE DETERMINATIONS"
positive_law: false
currency: "2026-04-05"
last_updated: "2026-04-05"
format_version: "1.1.0"
generator: "[email protected]"
authority: "Secs. 1102 and 1871 of the Social Security Act (42 U.S.C. 1302 and 1395hh)"
regulatory_source: "68 FR 63716, Nov. 7, 2003, unless otherwise noted."
cfr_part: "426"
---


# 426.455 Prohibited provisions of an ALJ's decision.

An ALJ's decision may not do any of the following:

(a) Order CMS or its contractors to add any language to a provision or provisions of an LCD.

(b) Order CMS or its contractors to pay a specific claim.

(c) Set a time limit for CMS or its contractors to establish a new or revised LCD.

(d) Review or evaluate an LCD other than the LCD under review.

(e) Include a requirement for CMS or its contractors that specifies payment, coding, or systems changes for an LCD, or deadlines for implementing these types of changes.

(f) Order or address how a contractor(s) must implement an LCD.