National Coverage Determination updates

Get updates on your Medicare coverage

The Centers for Medicare & Medicaid Services (CMS) periodically changes coverage rules for items and/or services. These changes are communicated through National Coverage Determinations (NCDs) updates.

See detailed NCD information or call Member Services at 1-877-232-7566 (TTY: 711), 8 am to 8 pm weekdays (year-round) and weekends (Oct. 1 – March 31).

The following list summarizes the most recent NCD updates:
 

SUPERVISED EXERCISE THERAPY (SET) FOR SYMPTOMATIC PERIPHERAL ARTERY DISEASE (PAD)

  • CMS retroactive effective date: May 25, 2017
  • CMS implementation date:  Jul. 2, 2018

Effective for claims with dates of service on or after May 25, 2017, CMS will cover SET when criteria is met.

For complete National Coverage Determination information, see NCD 20.35
 

NEXT GENERATION SEQUENCING

  • CMS retroactive effective date: March 16, 2018
  • CMS implementation date:  March 9, 2019

Effective for claims with dates of service on or after March 16, 2018, CMS will cover Next Generation Sequencing (NGS) as a diagnostic laboratory test when criteria is met.

For complete National Coverage Determination information, see NCD 90.2
 

IMPLANTABLE AUTOMATIC DEFIBRILLATORS (IAD)

  • CMS retroactive effective date:  Feb. 15, 2018
  • CMS implementation date: Feb. 26, 2019

Effective for claims with dates of service on or after Feb, 15, 2018, CMS will cover ICDs for the certain patient indications.

For complete National Coverage Determination information, see NCD 20.4
 

SCREENING FOR HEPATITIS B VIRUS (HBV) INFECTIONcreening for Hepatitis B Virus (HBV) Infection 

  • CMS retroactive effective date:  Sept. 28, 2016
  • CMS implementation date:  Jan. 2, 2018

Effective for dates of service on or after Sept. 28, 2016, screening for HBV infection will be covered when criteria is met.

For complete National Coverage Determination information, see NCD 210.6
 

PERCUTANEOUS IMAGE-GUIDED LUMBARr DECOMPRESSION (PILD) FOR LUMBAR SPINAL STENOSIS (LSS)

  • CMS retroactive effective date:  Dec. 7, 2016
  • CMS implementation date:  June 27, 2017

Effective for dates of service on or after Dec. 7, 2016, Medicare will cover PILD under Coverage with Evidence Development (CED) for beneficiaries with LSS who are enrolled in a CMS-approved prospective longitudinal study

For complete National Coverage Determination information, see NCD 150.13



LEADLESS PACEMAKERS

  • CMS retroactive effective date: Jan. 18, 2017
  • CMS implementation date: Aug. 29, 2017
Effective with dates of service Jan. 18, 2017, CMS will cover leadless pacemakers through Coverage with Evidence Development (CED) when procedures are performed in CMS-approved CED studies.

For complete National Coverage Determination information, see NCD 20.8.4.
 

SCREENING FOR HEPATITIS B VIRUS (HBV) INFECTION

  • CMS retroactive effective date: Sept. 28, 2016
  • CMS implementation date: Jan. 2, 2018
Effective with dates of service Sept. 28, 2016, CMS has determined that screening for HBV infection will be covered with the appropriate U.S. Food and Drug Administration (FDA) approved/cleared laboratory tests, used consistent with FDA-approved labeling and in compliance with the Clinical Laboratory Improvement Act (CLIA) regulations.

For complete National Coverage Determination information, see NCD 210.6.
 

PERCUTANEOUS LEFT ATRIAL APPENDAGE CLOSURE

  • CMS retroactive effective date: Feb. 8, 2016
  • CMS implementation date: Oct. 3, 2016
Effective with dates of service Feb. 8, 2016, CMS will cover Percutaneous Left Atrial Appendage Closure (LAAC) through Coverage with Evidence Development (CED) when LAAC is furnished in patients with Non-Valvular Atrial Fibrilation (NVAF) and according to an FDA approved indication for percutaneous LAAC with an FDA-approved device. 

For complete National Coverage Determination information, see NCD 20.34.