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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 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.

NCD Changes

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

See details on the CMS website: https://www.cms.gov/medicare-coverage-database/details/ncd-details.aspx?NCDId=110

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

See details on the CMS website: https://www.cms.gov/medicare-coverage-database/details/ncd-details.aspx?NCDId=372
Page updated 10/1/2019