- Members Overview
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- National Coverage Determinations
National Coverage Determinations
What Is a National Coverage Determination (NCD)?
Before deciding whether Medicare should cover a particular item (such as a brace or a hearing aid) or a service (such as therapy or screenings), the federal government conducts a comprehensive review process, and occasionally Congress may pass a law requiring coverage of a particular item or service. After coverage determinations or decisions are authorized, Medicare coverage is modified and Medicare carriers and other contractors (including Medicare Advantage organizations) coordinate their processes to fulfill these new coverage obligations. The formal name for these decisions which allow, limit, or exclude Medicare coverage is known as a national coverage determination (NCD). Coverage guidelines and effective dates are defined by Medicare or other rule making authority.
Below are changes that have been announced within the past year. It will be updated periodically. For more information, please contact Customer Service at 541-768-4550 or toll free 800-832-4580 (TTY 800-735-2900). Customer Service is available:
- Oct. 1 to March 31: Daily, from 8 a.m. to 8 p.m.
- April 1 to Sept. 30: Monday through Friday, from 8 a.m. to 8 p.m.
2021 NCD Changes
For more details, see the links below on the CMS Website.
Acupuncture for Chronic Lower Back Pain (cLBP) (30.3.3) – Updated 5/24/2021
Adult Liver Transplantation (260.1) – Updated 1/21/2021
Artificial Hearts and Related Devices (20.9) – Updated 6/7/2021
Chimeric Antigen Receptor (CAR) T-cell Therapy (110.24) – Updated 5/24/2021 – Benefits have changed
Colorectal Cancer Screening Tests (210.3) – Updated 5/24/2021 – Benefits have changed
Cytogenic Studies (190.3) – Updated 1/20/2021
Cyrosurgery of Prostate (230.9) – Updated 5/24/2021 – Benefits have changed
Erythropoiesis Stimulating Agents (ESAs) in Cancer and Related Neoplastic Conditions (110.21) – Updated 1/20/2021
External Counterpulsation (ECP) Therapy for Severe Angina (20.20) – Updated 6/7/2021
Extracorporeal Immunoadsorption (ECI) Using Protein A Columns (20.5) – Updated 1/20/2021
Intravenous Iron Therapy (110.10) – Updated 1/20/2021
Lung Cancer Screening with Low Dose Computed Tomography (LDCT) (210.14) – Updated 6/7/2021
Mammograms (220.4) – Updated 1/20/2021
Medical Nutrition Therapy (180.1) – Updated 1/20/2021
Next Generation Sequencing (NGS) (90.2) – Updated 6/7/2021
Percutaneous Image-Guided Breast Biopsy (220.13) – Updated 1/20/2021
Positron Emission Tomography (FDG) for Oncologic Conditions (220.6.17) – Updated 1/20/2021
Positron Emission Tomography (NaF-18) to Identify Bone Metastasis of Cancer (220.6.19) – Updated 6/7/2021
Screening for Hepatitis B Virus (HBV) Infection (210.6) – Updated 1/20/2021
Stem Cell Transplantation (Formerly 110.8.1)(110.23) – Updated 6/7/2021
Transcatheter Mitral Valve Repair (TMVR) (20.33) – Updated 6/7/2021
Vagus Nerve Stimulation (VNS) (160.18) – Updated 1/20/2021
2020 NCD Changes
Acupuncture for Chronic Lower Back Pain (cLBP) (30.3.3) – Updated 1/21/2020
See details on the CMS website. What’s new: The purpose of this change request is to inform MACs that CMS will cover acupuncture for chronic low back pain (cLBP) effective for claims with dates of service on and after Jan. 21, 2020.