National Coverage Determinations

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:

  • What benefits and services are covered

  • What benefits and services are changing

  • 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.


2022 NCD Changes

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:

  • A listing of all NCDs including both pending and closed coverage determinations

  • All national coverage analyses (NCAs) and final decision memos

  • A searchable NCD database