Updates to your Medicare coverage by CMS
National Coverage Determinations
What Is a National Coverage Determination (NCD)?
When Medicare changes coverage rules
The Centers for Medicare & Medicaid Services (CMS) sometimes change the coverage rules that apply to an item or service. When this happens, CMS issues a National Coverage Determination (NCD). It tells us:
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What benefits and services are covered
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What benefits and services are changing
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What Medicare will pay for an item or service
If you have any questions about your CDPHP® Medicare Advantage coverage, please contact Member Services at the number on your member ID card.
Please see our NCD notices below. For more details, visit the links below on the CMS website.
2024 NCD Changes
Allogeneic Hematopoietic Stem Cell Transplantation (HSCT) for Myelodysplastic Syndromes (MDS) – Updated 3/6/24
2023 NCD Changes
Beta Amyloid Positron Emission Tomography in Dementia and Neurodegenerative Disease – Updated 10/13/23
Percutaneous Transluminal Angioplasty (PTA) of the Carotid Artery Concurrent with Stenting – Updated 10/11/23
Seat Elevation Systems as an Accessory to Power Wheelchairs – Updated 5/16/23
2022 NCD Changes
Cochlear Implantation – Updated 9/26/22
Lung Cancer Screening with Low Dose Computed Tomography (LDCT) (210.14) – Updated 2/10/2022
Monoclonal Antibodies Directed Against Amyloid for the Treatment of Alzheimer’s Disease – New 4/7/2022
2021 NCD Changes
Acupuncture for Chronic Lower Back Pain (cLBP) (30.3.3) – Updated 5/24/2021
Adult Liver Transplantation (260.1) – Updated 1/21/2021
Artificial Hearts and Related Devices (20.9) – Updated 6/7/2021
Chimeric Antigen Receptor (CAR) T-cell Therapy (110.24) – Updated 5/24/2021 – Benefits have changed
Colorectal Cancer Screening Tests (210.3) – Updated 5/24/2021 – Benefits have changed
Cytogenic Studies (190.3) – Updated 1/20/2021
Cryosurgery of Prostate (230.9) – Updated 5/24/2021 – Benefits have changed
Erythropoiesis Stimulating Agents (ESAs) in Cancer and Related Neoplastic Conditions (110.21) – Updated 1/20/2021
External Counterpulsation (ECP) Therapy for Severe Angina (20.20) – Updated 6/7/2021
Extracorporeal Immunoadsorption (ECI) Using Protein A Columns (20.5) – Updated 1/20/2021
Home Use of Oxygen and Home Oxygen Use to Treat Cluster Headaches (240.5) Updated 09/27/2021
Intravenous Iron Therapy (110.10) – Updated 1/20/2021
Lung Cancer Screening with Low Dose Computed Tomography (LDCT) (210.14) – Updated 6/7/2021
Mammograms (220.4) – Updated 1/20/2021
Medical Nutrition Therapy (180.1) – Updated 1/20/2021
Next Generation Sequencing (NGS) (90.2) – Updated 6/7/2021
Percutaneous Image-Guided Breast Biopsy (220.13) – Updated 1/20/2021
Positron Emission Tomography (FDG) for Oncologic Conditions (220.6.17) – Updated 1/20/2021
Positron Emission Tomography (NaF-18) to Identify Bone Metastasis of Cancer (220.6.19) – Updated 6/7/2021
Screening for Hepatitis B Virus (HBV) Infection (210.6) – Updated 1/20/2021
Stem Cell Transplantation (Formerly 110.8.1)(110.23) – Updated 6/7/2021
Transcatheter Mitral Valve Repair (TMVR) (20.33) – Updated 6/7/2021
Vagus Nerve Stimulation (VNS) (160.18) – Updated 1/20/2021
2020 NCD Changes
Acupuncture for Chronic Lower Back Pain (cLBP) (30.3.3) – Updated 1/21/2020
See 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) – Updated 1/21/2020
Acupuncture for Fibromyalgia (30.3.1) – Updated 1/21/2020
Acupuncture for Osteoarthritis (30.3.2) – Updated 1/21/2020
For NCDs made more than 18 months ago, please visit the Medicare Coverage webpage on CMS.gov that provides:
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A listing of all NCDs including both pending and closed coverage determinations
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All national coverage analyses (NCAs) and final decision memos
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A searchable NCD database