National Coverage Determination
Know your rights, and learn exactly what's covered under Medicare, according to the latest determinations.
Effective Date | National Coverage Determination Description |
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January 19, 2021 | Transcatheter Edge-to-Edge Repair (TEER) for Mitral Value Regurgitation The Centers for Medicare and Medicaid (CMS) will cover a TEER of the mitral valve under Coverage with Evidence Development (CED) for the treatment of symptomatic moderate-to-severe or severe functional mitral regurgitation (MR) when the patient remains symptomatic despite stable doses of maximally tolerated Guideline-Directed Medical Therapy (GDMT) plus cardiac resynchronization therapy, if appropriate, or for the treatment of significant symptomatic degenerative MR when furnished according to an FDA-approved indication. The National Coverage Determination (NCD) also includes hospital infrastructure and procedural volume requirements, as well as operator procedural volume requirements.
For detailed coverage requirements, you may view the full text of the NCD at cms.gov/medicare-coverage-database/view/ncd.aspx?ncdid=363&ncdver=2&bc=0. |
January 19, 2021 | Colorectal Cancer Screening Blood-Based Biomarker Test The Centers for Medicare and Medicaid (CMS) will cover a blood-based biomarker test as an appropriate colorectal cancer screening test once every three years for Medicare beneficiaries when performed in a Clinical Laboratory Improvement Act (CLIA)-certified laboratory, when ordered by a treating physician and when all of the following requirements are met: The patient is:
For detailed coverage requirements, you may view the full text of the NCD at cms.gov/medicare-coverage-database/view/ncd.aspx?ncdid=281&ncdver=6. |
April 13, 2021 | Blood-Derived Products for Non-Healing Wounds The Centers for Medicare and Medicaid (CMS) will cover autologous Platelet-Rich Plasma (PRP) for the treatment of chronic non-healing diabetic wounds for a duration of 20 weeks, when prepared by devices whose FDA-cleared indications include the management of exuding cutaneous wounds, such as diabetic ulcers.
For detailed coverage requirements, you may view the full text of the NCD at cms.gov/medicare-coverage-database/view/ncd.aspx?ncdid=217&ncdver=6&bc=0. |
September 27, 2021 | Home Oxygen Use The Centers for Medicare and Medicaid (CMS) will cover oxygen therapy and oxygen equipment in the home for acute or chronic conditions, short- or long- term, when the patient exhibits hypoxemia.
For detailed coverage requirements, you may view the full text of the NCD at cms.gov/medicare-coverage-database/view/ncd.aspx?ncdid=169&ncdver=2. |
January 1, 2022 | 2022 Medical Nutrition Therapy The Centers for Medicare and Medicaid (CMS) will cover basic coverage of Medical Nutrition Therapy (MNT), for the first year a beneficiary receives MNT, with either a diagnosis of renal disease or diabetes is three hours of administration. Basic coverage in subsequent years for renal disease or diabetes is two hours. The dietitian/nutritionist may choose how many units are administered per day as long as all of the other requirements in this NCD are met. If the physician determines that receipt of both MNT and DSMT is medically necessary in the same episode of care, Medicare will cover both DSMT and MNT initial and subsequent years without decreasing either benefit as long as DSMT and MNT are not provided on the same date of service.
For detailed coverage requirements, you may view the full text of the NCD at cms.gov/medicare-coverage-database/view/ncd.aspx?ncdid=252. |
February 10, 2022 | Screening for Lung Cancer with Low Dose Computed Tomography (LDCT) The Centers for Medicare & Medicaid Services (CMS) reconsidered the national coverage determination established at section 210.14 of the Medicare National Coverage Determinations manual and has determined that the evidence is sufficient to expand the eligibility criteria for Medicare beneficiaries receiving low dose computed tomography (LDCT) when the following beneficiary eligibility criteria are met:
For detailed coverage requirements, you may view the full text of the NCD at cms.gov/medicare-coverage-database/view/ncacal-decision-memo.aspx?proposed=N&ncaid=304. |
April 7, 2022 | Monoclonal Antibodies Directed Against Amyloid for the Treatment of Alzheimer’s Disease The Centers for Medicare & Medicaid Services (CMS) covers Food and Drug Administration (FDA) approved monoclonal antibodies directed against amyloid for the treatment of Alzheimer’s disease (AD) when furnished in accordance with Section B (Coverage Criteria) under coverage with evidence development (CED) for patients who have:
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