NCD - National Coverage Determination

This option is available to Advanced or Standard subscribers only.

Watch a brief YouTube movie and see how easy it is to determine the NCD using ICD10Doc.

1. Using the free text search or reverse search functions on the Home page, find an NCD that interests you and then click on the NCD link that you'd like to continue with.
The free text search would look into the NCD title, description, indications / limitations
The reverse search would be conducted in the same way with or without the point in the NCD number. Thus 160.7.1 is the same as 16071 when searching with NCD number.



2. A specific NCD details the NCD number, title, description, indications, limitations, benefits category and the level of coverage that is supported nationally by a Medicare for reimbursement purposes.




Background

From Wikipedia: A national coverage determination (NCD) is a United States' nationwide determination of whether Medicare will pay for an item or service.
Medicare coverage is limited to items and services that are considered "reasonable and necessary" for the diagnosis or treatment of an illness or injury (and within the scope of a Medicare benefit category).
In the absence of a NCD, an item or service is covered at the discretion of the Medicare contractors based on a LCD - Local Coverage Determination.

From CMS web site: The National Coverage Determinations Manual describes whether specific medical items, services, treatment procedures, or technologies can be paid for under Medicare.
Where another statutory authority for denial is indicated, that is the sole authority for denial.
Where an item, service, etc. is stated to be covered,but such coverage is explicitly limited to specified indications or specified circumstances, all limitations on coverage of the items or services because they do not meet those specified indications or circumstances are based on ยง1862(a)(1) of the Act.
Where coverage of an item or service is provided for specified indications or circumstances but is not explicitly excluded for others, or where the item or service is not mentioned at all in the CMS Manual System the Medicare contractor is to make the coverage decision, in consultation with its medical staff, and with CMS when appropriate, based on the law, regulations, rulings and general program instructions. For more information on LCD visit CMS web site
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