National Coverage Determinations

The Centers for Medicare & Medicaid Services (CMS) makes changes to the services covered by Medicare. These changes are updated via National Coverage Determinations (NCDs). Here, you can learn about CMS’s NCD process and view summaries of recent NCDs – each with the effective date listed and a link to the full NCD.

• Effective 1/27/2016, Medicare is expanding national coverage for allogeneic hematopoietic stem cell transplantation (HSCT) for three separate medical conditions: Multiple Myeloma, Myelofibrosis, and Sickle Cell Disease. This coverage applies to certain beneficiaries who are participating in approved clinical studies. (Posted January 27,2016)
  Decision memo for Stem Cell Transplantation (Multiple Myeloma, Myelofibrosis, and Sickle Cell Disease) (CAG-0044R)
• Effective 2/28/2016, Medicare covers percutaneous left atrial appendage closure (LAAC) for non-valvular atrial fibrillation when the device has received FDA premarket approval and the beneficiary’s condition meets certain requirements. (Posted 2/8/2016)
  Decision Memo for Percutaneous Left Atrial Appendage (LAA) closure therapy (CAG-00445N)
• Effective for services performed on or after 7/9/2015, Medicare will cover testing for Human Papillomavirus (HPV) once every 5 years for beneficiaries without symptoms, aged 30 to 65 years, when performed with the Pap smear test for cervical cancer. (Posted 3/7/2016)
  National Coverage Determination (NCD) for Screening for Cervical Cancer with Human Papillomavirus (HPV) (210.21)
• Effective for services performed on or after 4/13/2015, Medicare will cover annual voluntary HIV screening for beneficiaries age 15 to 65 and for beneficiaries younger than 15 and older than 65 who are at increased risk for HIV infection. Medicare will cover a maximum of 3 voluntary screenings for pregnant beneficiaries under certain conditions. (Posted 3/7/2016)
  National Coverage Determination (NCD) for Screening for the Human Immunodeficiency Virus (HIV) Infection (210.7)
• Effective 8/30/2016, The Centers for Medicare & Medicaid Services (CMS) is not issuing a National Coverage Determination (NCD) at this time on gender reassignment surgery for Medicare beneficiaries with gender dysphoria because the clinical evidence is inconclusive for the Medicare population. For Medicare beneficiaries enrolled in Medicare Advantage (MA) plans, the initial determination of whether or not surgery would be reasonable and necessary will be made by the MA plans. (posted on 8/30/2016)
  Decision Memo for Gender Dysphoria and Gender Reassignment Surgery (CAG-00446N)
• Effective 9/28/2016, Medicare will cover a screening test for hepatitis B (HBV) infection in nonpregnant adolescents and adults without symptoms of the infection who are determined by their primary care providers to be at high risk. In addition, Medicare has determined that repeated screening would be appropriate annually only for beneficiaries with continued high risk who do not receive the hepatitis B vaccine. (Posted 09/28/2016)
  Decision Memo for Screening for Hepatitis B (HBV) Infection
• Effective 12/7/2016, The Centers for Medicare & Medicaid Services (CMS) has determined that percutaneous image-guided lumbar decompression (PILD) for lumbar spinal stenosis (LSS) is not reasonable and necessary under section 1862(a)(1)(A) of the Social Security Act. Medicare will cover PILD procedures in certain cases when provided in a CMS-approved prospective and longitudinal clinical research study. (Posted December 7, 2016)
  Decision Memo for Percutaneous Image-guided Lumbar Decompression for Lumbar Spinal Stenosis (CAG-00433R)
• Effective 8/29/2017, The Centers for Medicare & Medicaid Services (CMS) has signaled its intent to cover leadless pacemakers through Coverage with Evidence Development (CED). Medicare covers leadless pacemakers when procedures are performed in certain FDA approved studies. Medicare will cover, in CMS-approved prospective long-term studies, leadless pacemakers that are used in accordance with the FDA approved label for devices that have either:
  • An associated ongoing FDA approved post-approval study; or
  • Completed an FDA post-approval study (Posted January 18, 2017)
• Decision Memo for Leadless Pacemakers (CAG-00448N)
• Effective 4/3/2017, The Centers for Medicare and Medicaid Services (CMS) has amended its previous National Coverage Determination (NCD) for HBO therapy by removing Section C from the NCD, which previously considered the application of topical oxygen for chronic wounds as nationally non-covered. The coverage of topical oxygen for this purpose will be determined by the local Medicare Administrative Contractors. (Posted 4/3/2017)
  Decision Memo for Hyperbaric Oxygen (HBO) Therapy (Section C, Topical Oxygen
• Effective for services performed on or after May 25, 2017, The Centers for Medicare & Medicaid Services (CMS) will cover supervised exercise therapy (SET) for beneficiaries with intermittent claudication (IC) for the treatment of symptomatic peripheral artery disease (PAD) when provided in a qualified SET program and the beneficiary’s condition meets certain criteria. (Posted May 25, 2017)
  Decision memo for Supervised Exercise Therapy for Peripheral Artery Disease (CAG-00449N)