National Coverage Determinations

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.

See more details 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 5/24/2021

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 5/24/2021

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 5/24/2021

Mammograms (220.4) – Updated 1/20/2021

Medical Nutrition Therapy (180.1) – Updated 1/20/2021

Next Generation Sequencing (NGS) (90.2) – Updated 5/24/2021

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 05/24/2021

Screening for Hepatitis B Virus (HBV) Infection (210.6) – Updated 1/20/2021

Stem Cell Transplantation (Formerly 110.8.1)(110.23) – Updated 5/23/2021

Transcatheter Mitral Valve Repair (TMVR) (20.33) – Updated 5/24/2021

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.

Acupuncture (30.3) – Updated 1/21/2020

Acupuncture for Fibromyalgia (30.3.1) – Updated 1/21/2020

Acupuncture for Osteoarthritis (30.3.2) – Updated 1/21/2020