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 Monday through Friday from 8 a.m. to 8 p.m. at 541-768-4550 or toll free 800-832-4580. TTY users should call 800-735-2900.

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.

Acupuncture (30.3) — 1/21/2020

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

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

See Acupuncture for Osteoarthritis 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.

Implantable Automatic Defibrillators (20.4) — 2/15/2018

See Implantable Automatic Defibrillators details on the CMS website.

Next Generation Sequencing (NGS) (90.2) — 3/16/2018

See Next Generation Sequencing details on the CMS website.

Transcatheter Aortic Valve Replacement (TAVR) (20.32) — 6/21/2019

See Transcatheter Aortic Valve Replacement details on the CMS website.