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National Coverage Determination (NCD)

NCDs are developed by CMS to describe the circumstances for Medicare coverage nationwide for a specific medical service procedure or device. NCDs generally outline the conditions for which a service is considered to be covered (or not covered) and usually issued as a program instruction. A list of all CMS NCDs is available on the CMS website This link takes you to an external website..

An overview of the Medicare Coverage Database (MCD) is located at http://www.cms.gov/mcd/overview.asp This link takes you to an external website. on the CMS website with multiple links to other valuable sites and information.

Topic Brief Description
Arthroscopic Lavage and Arthroscopic Debridement for Osteoarthritic Knees View coverage guidelines for Arthroscopic Lavage and Debridement for Osteoarthritic Knees
Bariatric Surgery Coverage [PDF] This describes bariatric surgery procedures defined by NCD as reasonable and necessary under specified conditions for the treatment of complications of morbid obesity.
Ocular Photodynamic (OPT) Therapy with Verteporfin View national coverage of photodynamic therapy with Verteporfin, including additional Noridian determined indications. 
Outpatient Cardiac Rehabilitation View coverage, coding and billing information for Outpatient Cardiac Rehabilitation defined by the SSA, NCD and CMS manuals, including contractor determined coding criteria.
Percutaneous Endovascular Cardiac Assist Procedures and Devices View coverage, coding and billing information for Percutaneous Endovascular Cardiac Assist Procedures and Devices defined by the SSA.
Positron Emission Tomography (PET) Scans Coverage [PDF] This describes the least restrictive possible PET coverage. Providers must read the entire NCD and related Internet Only Manual (IOM) sections (see "Sources" at the end of this article) in order to correctly understand and apply the following coding guidance. 
Sacral Nerve Stimulation for Urinary and Fecal Incontinence This describes coverage of Sacral Nerve Stimulation for urinary incontinence for the treatment of urinary urge incontinence, urge-frequency syndrome, and urinary retention as defined by the CMS National Coverage Determination (NCD) 230.18.
Single Chamber and Dual Chamber Permanent Pacemakers – Coding and Billing View coverage, coding and billing information for Single Chamber and Dual Chamber Permanent Pacemakers defined by the Social Security Administration (SSA), National Coverage Determination (NCD) and CMS manuals, including contractor determined coding criteria.
Sterilization View coverage and billing requirements for sterilization services to prevent reproduction. 

 

Last Updated Dec 22, 2016