Medicare National Coverage Determinations

CMS coverage policies affecting all Medicare plans

A National Coverage Determination (NCD) is a nationwide determination of whether Medicare will pay for an item or service.

Medicare coverage is limited to clinically proven items and services that are reasonable and necessary for the diagnosis or treatment of an illness or injury (and within the scope of a Medicare benefit category). National Coverage Determinations are made through an evidence-based process, with opportunities for public participation. In some cases, the Centers for Medicare & Medicaid Services' (CMS) own research is supplemented by an outside technology assessment and/or consultation with the Medicare Evidence Development & Coverage Advisory Committee.

In the absence of a national coverage policy, an item or service may be covered at the discretion of the Medicare contractors based on a Local Coverage Determination.

Once an NCD is finalized and published, its coverage guidelines are binding nationwide. It is important to discuss the medical necessity of your medical care with your doctor. Items and services that are not determined by Medicare to be medically necessary will not be covered by Medicare or our plan.

Updates to National Coverage Determinations

When the Centers for Medicare & Medicaid Services (CMS) updates the NCDs, the changes can be found here:

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