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.

Adult Liver Transplantation (260.1) – 01/21/2021

See Adult Liver Transplantation details on the CMS website.

Artificial Hearts and Related Devices (20.9) - 3/25/2021

See Artificial Hearts and Related Devices details on the CMS website.

Cytogenic Studies (190.3) - 1/20/2021

See Cytogenic Studies details on the CMS website.

Cyrosurgery of Prostate (230.9) - 3/25/2021

See Cyrosurgery of Prostate details on the CMS website.

Erythropoiesis Stimulating Agents (ESAs) in Cancer and Related Neoplastic Conditions (110.21) - 1/20/2021

See Erythropoiesis Stimulating Agents (ESAs) in Cancer and Related Neoplastic Conditions details on the CMS website.

External Counterpulsation (ECP) Therapy for Severe Angina (20.20) - 3/25/2021

See External Counterpulsation (ECP) Therapy for Severe Angina details on the CMS website.

Extracorporeal Immunoadsorption (ECI) Using Protein A Columns (20.5) - 1/20/2021

See Extracorporeal Immunoadsorption (ECI) Using Protein A Columns details on the CMS website. 

Intravenous Iron Therapy (110.10) - 1/20/2021

See Intravenous Iron Therapy details on the CMS website.

Lung Cancer Screening with Low Dose Computed Tomography (LDCT) (210.14) - 3/25/2021

See Lung Cancer Screening with Low Dose Computed Tomography (LDCT) details on the CMS website.

Mammograms (220.4) - 01/20/2021

See Mammograms details on the CMS website.

Medical Nutrition Therapy (180.1) - 1/20/2021

See Medical Nutrition Therapy details on the CMS website.

Next Generation Sequencing (NGS) (90.2) - 3/25/2021

See Next Generation Sequencing (NGS) details on the CMS website.

Percutaneous Image-Guided Breast Biopsy (220.13) - 1/20/2021

See Percutaneous Image-Guided Breast Biopsy details on the CMS website.

Positron Emission Tomography (FDG) for Oncologic Conditions (220.6.17) - 1/20/2021

See Positron Emission Tomography (FDG) for Oncologic Conditions details on the CMS website.

Positron Emission Tomography (NaF-18) to Identify Bone Metastasis of Cancer (220.6.19) - 03/30/2021

See Positron Emission Tomography (NaF-18) to Identify Bone Metastasis of Cancer details on the CMS website.

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

See Screening for Hepatitis B Virus (HBV) Infection details on the CMS website.

Stem Cell Transplantation (Formerly 110.8.1)(110.23) – 03/30/2021

See Stem Cell Transplantation details on the CMS website.

Transcatheter Mitral Valve Repair (TMVR) (20.33) - 03/30/2021

See Transcatheter Mitral Valve Repair (TMVR) details on the CMS website.

Vagus Nerve Stimulation (VNS) (160.18) - 1/20/2021

See Vagus Nerve Stimulation (VNS) details on the CMS website. 

2020 NCD Changes

Acupuncture for Chronic Lower Back Pain (cLBP) (30.3.3) — 1/21/2020

See Acupuncture for Chronic Lower Back Pain 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) — 1/21/2020

See Acupuncture details on the CMS website

Acupuncture for Fibromyalgia (30.3.1) — 1/21/2020

See Acupuncture for Fibromyalgia details on the CMS website.

Acupuncture for Osteoarthritis (30.3.2) — 1/21/2020

See Acupuncture for Osteoarthritis details on the CMS website.