What are NCDs?


A national coverage determination (NCD) sets forth whether Medicare will cover, or not cover, specific services, procedures, or technologies on a national basis. Medicare contractors are required to follow NCDs. If an NCD does not specifically exclude an indication or circumstance, or if the item or service is not mentioned at all in an NCD or in a Medicare manual, it is up to the Medicare contractor to make the coverage decision (see local coverage determinations). Prior to an NCD taking effect, CMS must first issue a manual instruction, program memorandum, CMS ruling, or Federal Register notice giving specific directions to claims-processing contractors. That issuance, which includes the effective date, is the NCD. If appropriate, the agency must also change billing and claims processing systems and issue related instructions to allow for payment. The NCD will be published in the Medicare NCD Manual. An NCD becomes effective as of the date listed in the transmittal that announces the revision.

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