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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. In rare instances, if there is contradicting information in the NCD and LCD, the NCD overrides the LCD. View all NCDs This link will take you to an external website. on the CMS website.

Additional Noridian Coverage Requirement Articles

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] View bariatric surgery procedures defined by NCD as reasonable and necessary under specified conditions for the treatment of complications of morbid obesity.
Intravenous Immune Globulin (IVIg) - NCD 250.3 View NCD 250.3 coverage guidelines for intravenous immune globulin.
Ocular Photodynamic (OPT) Therapy with Verteporfin View coverage, coding and billing information for Ocular Photodynamic (OPT) Therapy with Verteporfin defined by the SSA, NCD and CMS manuals, including contractor determined coding criteria.
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 Scans Coverage [PDF] View 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  View 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 Jul 14, 2017