The Centers for Medicare & Medicaid Services (CMS) has issued the following National Coverage Determinations to communicate important changes. Changes by Date, starting with most recent
Effective March 6, 2024
National Coverage Determination (NCD) 110.23, Allogeneic Hematopoietic Stem Cell Transplantation (HSCT) for Myelodysplastic Syndromes (MDS)
On March 6, 2024, CMS issued a final decision under National Coverage Determination (NCD) 110.23 to expand Medicare coverage for allogeneic hematopoietic stem cell transplant using bone marrow, peripheral blood or umbilical cord blood stem cell products for Medicare patients with MDS who have prognostic risk scores of:
- ≥ 1.5 (Intermediate-2 or high) using the International Prognostic Scoring System (IPSS), or
- ≥ 4.5 (high or very high) using the International Prognostic Scoring System - Revised (IPSS-R), or
- ≥ 0.5 (high or very high) using the Molecular International Prognostic Scoring System (IPSS-M)
Additional instruction may be found in: Publication (Pub) 100-03, NCD Manual, chapter 1, section 110.23, for information regarding this NCD and Pub. 100-04, Claims Processing Manual (CPM), chapter 3, section 90.3.1.
Effective Jan. 1, 2023:
CMS issued a change request to make contractors aware of policy updates resulting from changes specified in the Calendar Year (CY) 2023 Physician Fee Schedule (PFS) Final Rule. The policy updates include removal of one selected National Coverage Determination (NCD): Ambulatory Electroencephalographic (EEG) Monitoring and Expanding Coverage of Colorectal Cancer Screening.
Transmittal 11865 issued February 16, 2023, is being rescinded and replaced by Transmittal 12299, dated October 12, 2023, to provide clarifications on CMS policy and related claims processing instructions for our approach to colonoscopies within the context of a complete colorectal cancer screening by revising the policy section with additional verbiage, adding Business Requirement (BR) 13017 - 04.5.3, and revising BRs 13017-04.1 and 13017 - 04.4 to 13017 - 04.10. This CR is amended to remove the requirement (and corresponding Pub. 100-04 narrative) that contractors shall return to provider/ return as un-processable certain screening colonoscopy claims that do not include the KX modifier. This correction does not make any revisions to the companion Pub. 100-02 or Pub. 100-03; all revisions are associated with Pub. 100-04. All other information remains the same.
Separately, the policy updates also include policies to expand colorectal cancer screening coverage by:
- Reducing the minimum age for certain Colorectal Cancer (CRC) screening tests from 50 to 45 years
- Expanding the regulatory definition of CRC screening tests to include a follow-on screening colonoscopy after a Medicare covered non-invasive stool-based test returns a positive result.
Effective October 11 , 2023
National Coverage Determination (NCD) 20.7 Percutaneous Transluminal Angioplasty (PTA) of the Carotid Artery Concurrent with Stenting
On October 11, 2023, CMS issued an NCD updating coverage under section B4 of NCD 20.7. The updated NCD covers PTA of the carotid artery concurrent with stenting with the placement of an FDA-approved carotid stent with an FDA-approved or cleared embolic protection device, for Medicare beneficiaries with symptomatic carotid artery stenosis ≥50% and asymptomatic carotid artery stenosis ≥70%. As a result of the revised eligibility criteria for this NCD, CMS is replacing the current text of 20.7 sections B4 and D of the NCD Manual, Publication (Pub.) 100-03, Chapter 1, Part 1, and Chapter 32, Section 160 of the Claims Processing (MCP) Manual, Pub. 100-04.
Effective Aug. 17, 2023
CMS issued a memo regarding the Significant Cost Determination for Medicare Coverage of Monoclonal Antibodies for the Treatment of Alzheimer's Disease
CMS has determined that the cost of coverage for monoclonal antibodies that target amyloid (or plaque) for the treatment of Alzheimer's disease under NCD 200.3 does not meet the significant cost threshold. Therefore, MA plans are required to assume the costs and cover anti-amyloid monoclonal antibodies antibody treatments for Alzheimer’s following the coverage criteria set forth under NCD 200.3.
Consistent with procedures under Traditional Medicare, Medicare Advantage plans must collect the applicable registry trial number on each claim or encounter for monoclonal antibodies that receive traditional approval from the FDA.
Effective Aug. 4, 2023
CMS has advised of the following policy updates effective for claims with dates of service on and after January 1, 2024
The changes in this update include:
- One initial acupuncture HCPCS (97810 OR 97813) shall be allowed to be reported with or without HCPCS add-on code(s) (97811 AND/OR 97814) on the same date of service (DOS) and this equals one session. Only one initial code HCPCS 97810 OR 97813 can be reported per DOS.
- Dry needling HCPCS 20560 OR 20561 shall be allowed to be reported and this equals one session. Dry needling and acupuncture are disallowed on the same DOS. HCPCS 20560 & 20561 are disallowed on the same DOS as HCPCS 97810, 97811, 97813, or 97814).
- All other existing editing other than the frequency described above that is contained in CRs 11755, 12480, and 12822, remain in effect
Effective July 31, 2023
CMS issued the transmittal 12112 to communicate the proposed technical manual changes that were made to the National Coverage Determination (NCD) Manual, Publication 100-03, Chapter 1 Parts 1, 3, and 4.
The changes in this update include:
- In Chapter 1, Part 1, Section 20.33 Transcatheter Edge-To-Edge (TEER) for Mitral Valve Regurgitation title was corrected to align with the title of the NCD.
- In Chapter 1, Part 1, Section 20.4 Implantable Cardioverter Defibrillators (ICDs), in Part B number 4 added verbiage ‘or cardiac arrest due to VF’ to align with Section I of the Final Decision Memo.
- In Chapter 1, Part 3, Section 190.1 Histocompatibility Testing, removed 4 bullets and replaced them with letters to align with the original Coverage Issues Manual language.
- In Chapter 1, Part 4, Section 280.1, in the DME reference list, the Muscle Stimulator hyperlink is being changed from 250.4 to 160.12 to refer back to the correct section in the manual.
Effective May 16, 2023
CMS issued a Benefit Category Determination and National Coverage Determination (NCD 280.16) for power seat elevation equipment on certain power wheelchairs.
Effective for claims with dates of service on or after May 16, 2023, Power seat elevation equipment is reasonable and necessary for individuals using complex rehabilitative power-driven wheelchairs when the following conditions are met under NCD 280.16:
- The individual has undergone a specialty evaluation that confirms the individual’s ability to safely operate the seat elevation equipment in the home. This evaluation must be performed by a licensed/certified medical professional such as a physical therapist (PT), occupational therapist (OT), or other practitioner, who has specific training and experience in rehabilitation wheelchair evaluations; and
- At least one of the following apply:
- The individual performs weight bearing transfers to/from the power wheelchair while in the home, using either their upper extremities during a non-level (uneven) sitting transfer and/or their lower extremities during a sit to stand transfer. Transfers may be accomplished with or without caregiver assistance and/or the use of assistive equipment (e.g., sliding board, cane, crutch, walker); or,
- The individual requires a non-weight bearing transfer (e.g., a dependent transfer) to/from the power wheelchair while in the home. Transfers may be accomplished with or without a floor or mounted lift; or,
- The individual performs reaching from the power wheelchair to complete one or more mobility related activities of daily living (MRADLs) such as toileting, feeding, dressing, grooming and bathing in customary locations within the home. MRADLs may be accomplished with or without caregiver assistance and/or the use of assistive equipment.
Effective Jan. 1, 2023
CMS issued a change request to make contractors aware of policy updates resulting from changes specified in the Calendar Year (CY) 2023 Physician Fee Schedule (PFS) Final Rule. The policy updates include removal of one selected National Coverage Determination (NCD): Ambulatory Electroencephalographic (EEG) Monitoring.
Date of Transmittal: Jan. 27, 2023
*Unless otherwise specified, the effective date is the date of service.
IMPLEMENTATION DATE: Feb. 27, 2023 - Requirements Implementation Date; April 1, 2023 - For Release Tracking Purposes Only
Separately, the policy updates also include policies to expand colorectal cancer screening coverage by:
- Reducing the minimum age for certain Colorectal Cancer (CRC) screening tests from 50 to 45 years
- Expanding the regulatory definition of CRC screening tests to include a follow-on screening colonoscopy after a Medicare covered non-invasive stool-based test returns a positive result.
NCD Removal:
CMS finalized a proposal to remove NCD 160.22 EEG Monitoring
CRC Screening:
- The minimum age payment and/or coverage limitation for the following CRC screening tests is now reduced to 45 years of age or older:
- Screening Flexible Sigmoidoscopy Test
- Screening Guaiac-based Fecal Occult Blood Test (gFOBT)
- Screening Immunoassay-based Fecal Occult Blood Test (iFOBT)
- Screening The Cologuard™ – Multi-target Stool DNA (sDNA) Test
- Screening Barium Enema Test
- Screening Blood-based Biomarker Test
Effective Jan. 1, 2023
CMS issued Transmittal 11597 to inform the Medicare Administrative Contractors (MACs) of the changes to NCD 240.2
CMS issued transmittal to communicate the revision of 240.2 of the National Coverage Determination (NCD) Manual, Publication (Pub.) 100-03, Chapter 1, Part 4, and to inform the Medicare Administrative Contractors (MACs) of the changes associated with this NCD, effective Sept. 27, 2021, as amended July 8, 2022.
On July 8, 2022, CMS reconsidered and amended NCD 240.2 narrowly in order to conform the period of initial coverage described in section D with the specific time period specified in §1834(a)(5)(E) of the Social Security Act. Specifically, CMS amended the period of initial coverage for patients in section D of NCD 240.2 from 120 days to 90 days, in order to align with the 90-day statutory time period. No other part of NCD 240.2 was reconsidered or amended. Since §1834(a)(5)(E) of the Social Security Act was the continuous controlling authority, the coverage policies in NCD 240.2 remain effective as of Sept. 27, 2021.
Effective Sept. 26, 2022
CMS sent notice that a final NCD and decision memo for cochlear implantation has been posted.
CMS is broadening the patient criteria and removing the requirement that for individuals with hearing test scores of > 40% and ≤ 60%, Cochlear Implantation may be covered:
Only when the provider is participating in and patients are enrolled in either an FDA-approved category B IDE clinical trial, a trial under the CMS Clinical Trial Policy, or a prospective, controlled comparative trial approved by CMS.
CMS concluded that the evidence is sufficient to determine that Cochlear Implantation may be covered for treatment of bilateral pre- or post-linguistic, sensorineural, moderate-to-profound hearing loss in individuals who demonstrate limited benefit from amplification. Limited benefit from amplification is defined by test scores of less than or equal to 60% correct in the best-aided listening condition on recorded tests of open-set sentence cognition. Patients must meet all of the following criteria.
- Diagnosis of bilateral moderate-to-profound sensorineural hearing impairment with limited benefit from appropriate hearing (or vibrotactile) aids;
- Cognitive ability to use auditory clues and a willingness to undergo an extended program of rehabilitation;
- Freedom from middle ear infection, an accessible cochlear lumen that is structurally suited to implantation, and freedom from lesions in the auditory nerve and acoustic areas of the central nervous system;
- No contraindications to surgery; and
- The device must be used in accordance with Food and Drug Administration (FDA)-approved labeling.
Effective April 7, 2022
CMS Transmittal – National Coverage Determination (NCD) 200.3 – Monoclonal Antibodies Directed Against Amyloid for the Treatment of Alzheimer’s Disease (AD)
Effective April 7, 2022, 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 the coverage criteria under coverage with evidence development (CED) for patients who have a clinical diagnosis of mild cognitive impairment (MCI) due to AD or mild AD dementia, both with confirmed presence of amyloid beta pathology consistent with AD.
Monoclonal antibodies directed against amyloid indicated for the treatment of AD are covered when furnished according to the FDA-approved indication in National Institutes of Health (NIH)-supported trials.
For any CMS-approved study or NIH-supported trial that includes a beta amyloid positron emission tomography (PET) scan as part of the protocol, it has been determined that these trials or studies also meet the CED requirements included in the Beta Amyloid PET in Dementia and Neurodegenerative Disease NCD (220.6.20).
Monoclonal antibodies directed against amyloid for the treatment of AD provided outside of an FDA approved randomized controlled trial, CMS approved studies, or studies supported by the NIH, are nationally non-covered.
Individually approved clinical trials require a new HCPCS code specific to the therapy being studied. Therapies with FDA approval that have not been assigned a dedicated HCPCS code would be identified by existing HCPCS codes J3490, J3590. Subsequent Transmittals will follow.
Effective April 7, 2022
CMS approved use of monoclonal antibodies directed against amyloid for the treatment of Alzheimer’s disease under certain coverage criteria
The Centers for Medicare & Medicaid Services (CMS) 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:
A clinical diagnosis of mild cognitive impairment (MCI) due to AD or mild AD dementia, both with confirmed presence of amyloid beta pathology consistent with AD.
Effective Feb. 10, 2022
CMS is expanding beneficiary eligibility for screening for lung cancer with Low Dose Computed Tomography (LDCT). May 3, 2022 update
CMS issued a change request to inform interested parties that it is expanding beneficiary eligibility for screening for lung cancer with LDCT.
The changes in this update include:
- Expanding beneficiary eligibility for screening for lung cancer with LDCT to closely align with the USPSTF recommendation
- Lowering the minimum age for screening from 55 to 50 years
- Reducing the smoking history from at least 30 pack-years to at least 20 pack-years
- Simplifies requirements for the counseling and shared decision-making visit
- Removes the restriction that it must be furnished by a physician or non-physician practitioner
- Reduces the eligibility criteria for the reading radiologist
- Reduces the radiology imaging facility eligibility criteria
Note: As a result of the revised eligibility criteria for this NCD, CMS is replacing the current text of Section 210.14 of the NCD Manual, Publication (Pub.) 100-03, Chapter 1, Part 4, and section 220, chapter 18 of the Claims Processing Manual, Pub. 100-04.
Effective Feb. 10, 2022
CMS is expanding the eligibility criteria for Medicare beneficiaries receiving low dose computed tomography (LDCT), March 2, 2022 update
The Centers for Medicare & Medicaid Services (CMS) announced a final decision for a national coverage determination (NCD) titled Screening for Lung Cancer with Low Dose Computed Tomography (LDCT) (CAG-00439R), which expands coverage for lung cancer screening with low dose computed tomography (LDCT) to improve health outcomes for people with lung cancer.
Medicare beneficiaries may receive low dose computed tomography (LDCT) when the following criteria are met:
- Age 50–77 years
- Asymptomatic (no signs or symptoms of lung cancer)
- Tobacco smoking history of at least 20 pack-years (1 pack-year = smoking 1 pack per day for 1 year; 1 pack = 20 cigarettes)
- Current smoker or one who has quit smoking within the last 15 years
- Received an order for lung cancer screening with LDCT
This final decision:
- Simplifies requirements for the counseling and shared decision-making visit
- Removes the requirement for the reading radiologist to document participation in continuing medical education
CMS added a requirement back to the NCD criteria for radiology imaging facilities to use a standardized lung nodule identification, classification and reporting system.
Effective Jan. 1, 2022
CMS provided updated instructions on how to process claims in the Part B physician office and independent clinics for Chimeric Antigen Receptor (CAR) T-Cell Therapy.
The Centers for Medicare & Medicaid Services (CMS) reviewed the evidence for CAR T-cell therapy in patients with cancer, and will cover Food and Drug Administration (FDA)-approved CAR T-cell therapy under the conditions specified in Publication 100-03, National Coverage Determination (NCD) Manual, section 110.24. Effective for claims with dates of service on or after August 7, 2019, CMS covers autologous treatment for cancer with T-cells expressing at least one CAR when administered at healthcare facilities enrolled in the FDA REMS and used for a medically accepted indication as defined at Social Security Act section 1861(t)(2); i.e., is used for either an FDA-approved indication (according to the FDA approved label for that product), or for other uses when the product has been FDA-approved and the use is supported in one or more CMS-approved compendia.
Update Dec. 30, 2022
Transmittal 11721 issued Nov. 28, 2022, is being rescinded and replaced by Transmittal 11774, dated, Dec. 30, 2022 to revise the implementation date and to:
- Remove duplicate Business Requirement (BR) 12928.3 and replace with the intended language,
- Clarify 1 unit per HCPCS code in BRs 12928.7, 12928.8, 12928.8.1,
- Clarify modifier -Q1 not -Q0 in BRs 12928.10, 12928.11,
- Change date to Oct. 1, 2021 in BR 12928.11,
- Remove Part A from BR 12928.8.1,
- Where discussing NCD 310.1 replace 'FDA-approved' with 'qualifying clinical trial'.
- Revise the IOM, the background section of the requirements, and the NCD excel file.
All other information remains the same.
Effective Jan. 1, 2022
CMS announces removal of 2 national coverage determinations (NCDs), Feb. 18, 2022 update
The purpose of this Omnibus change request is to make Medicare contractors aware of the updates to remove 2 National Determination NCDs.
The following 2 NCDs are being removed from the NCD Manual:
- NCD 180.2 Enteral/Parenteral Nutritional Therapy
- NCD 220.6 Positron Emission Tomography (PET) Scans
Coverage of the above 2 NCDs revert to MAC discretion effective for claims with dates of service on and after Jan. 1, 2022.
Effective April 13, 2021
CMS issued an NCD for autologous platelet-rich plasma (PRP) for the treatment of chronic non-healing diabetic wounds under specific conditions
Effective for claims with dates of service on and after April 13, 2021, CMS will cover autologous PRP for treating chronic non-healing diabetic wounds for a duration of 20 weeks. The autologous PRP used for treatment must be prepared by devices whose FDA-cleared indications include the management of exuding cutaneous wounds such as diabetic ulcers.
Coverage of autologous PRP for the treatment of chronic non-healing diabetic wounds beyond 20 weeks will be determined by local MACs. Coverage of autologous PRP for the treatment of all other chronic non-healing wounds will be determined by local MACs.
Effective Jan. 19, 2021
CMS issued a reconsideration of a previous NCD expanding coverage of mitral valve Transcatheter Edge-to-Edge Repair (TEER) procedures
This NCD is for mitral valve TEER procedures treating functional mitral regurgitation (MR) and maintained coverage of TEER for treating degenerative MR through coverage with evidence development (CED) and with mandatory registry participation.
Specifically, CMS covers TEER of the mitral valve under CED for treating symptomatic, moderate-to-severe or severe functional MR. This is covered when the patient remains symptomatic despite stable doses of maximally tolerated guideline-directed medical therapy (GDMT) plus cardiac resynchronization therapy, if appropriate. CMS may also cover TEER for treating significant symptomatic degenerative MR when furnished according to an FDA-approved indication. The NCD also includes hospital infrastructure and procedural volume requirements as well as operate procedural volume requirements.
Effective Jan. 19, 2021
Screening for Colorectal Cancer (CRC)-Blood-Based Biomarker Tests
CMS has issued an NCD for screening for colorectal cancer. For services performed on or after Jan. 19, 2021, CMS has determined that a blood-based biomarker test is an appropriate colorectal cancer screening test once every 3 years for Medicare beneficiaries when it is:
- Performed in a Clinical Laboratory Improvement Act (CLIA)-certified laboratory
- Ordered by a treating physician
Additionally, all of the requirements below must be met. The patient is:
- Age 50–85 years
- Asymptomatic (no signs or symptoms of colorectal disease including but not limited to lower gastrointestinal pain, blood in stool, positive guaiac fecal occult blood test or fecal immunochemical test)
- At average risk of developing colorectal cancer (no personal history of adenomatous polyps, colorectal cancer or inflammatory bowel disease, including Crohn’s disease and ulcerative colitis; no family history of colorectal cancers or adenomatous polyps, familial adenomatous polyposis or hereditary nonpolyposis colorectal cancer)
The blood-based biomarker screening test must have all of the following:
- FDA market authorization with an indication for colorectal cancer screening
- Proven test performance characteristics for a blood-based screening test with both sensitivity greater than or equal to 74% and specificity greater than or equal to 90% in the detection of colorectal cancer compared to the recognized standard (accepted as colonoscopy at this time), based on the pivotal studies included in the FDA labeling
Effective July 1, 2020
Update to the Medicare NCD Manual
CMS issued an update to the Medicare National Coverage Determinations (NCD) Manual regarding Next-Generation Sequencing (NGS). An NCD that expands Original Medicare coverage and is also binding on Medicare Advantage organizations.
CMS has rescinded and replaced Transmittal 11055 (LRR-2021-GOV-5629445) with Transmittal 11461.CMS has revised Business Requirement 12483.1 and the corresponding spreadsheet to align with changes made in previous change requests.
All other information remains the same.
Effective Dec. 1, 2020
Ventricular Assist Devices (VADs)
CMS notified their MACs that they will cover ventricular assist devices (VADs) under certain conditions and criteria. VADs, or left ventricular assist devices (LVADs), are mechanical blood pumps that are surgically attached to 1 or both intact ventricles of a damaged or weakened heart to assist in pumping blood. Section 20.9.1 of the Medicare NCD Manual established conditions of coverage for VADs.
An NCD that expands coverage is also binding on a Medicare Advantage organization.
VADs and LVADs are covered if they are FDA approved for short-term (e.g., bridge-to-recovery and bridge-to-transplant) or long-term (e.g., destination therapy) mechanical circulatory support for heart failure patients who meet the following criteria:
- Have New York Heart Association (NYHA) Class IV heart failure
- Have a left ventricular ejection fraction (LVEF) equal to or less than 25%
- Are inotrope dependent or have a cardiac index (CI) of 2.2 L/min/m2 while not on inotropes
The patient must also meet 1 of the following conditions:
- Is on optimal medical management (OMM), based on current heart failure practice guidelines for at least 45 out of the last 60 days and is failing to respond
- Have advanced heart failure for at least 14 days and is dependent on an intra‐aortic balloon pump (IABP) or similar temporary mechanical circulatory support for at least 7 days
Beneficiaries receiving a VAD or LVAD must be managed by a team of medical professionals based at the facility and the team must include individuals with experience working with patients before and after placement of a VAD or LVAD. The team must include:
- At least 1 physician with cardiothoracic surgery privileges and individual experience implanting at least 10 durable, intracorporeal LVADs over the course of the previous 36 months with activity in the last year
- At least 1 cardiologist trained in advanced heart failure with clinical competence in medical- and device-based management including VADs, and clinical competence in the management of patients before and after placement of a VAD
- A VAD program coordinator
- A social worker
- A palliative care specialist
CMS posted on the
ICD-10 and Coding Revisions, starting with most recent
The National Coverage Determination coding revisions below include International Classification of Diseases and Tenth Revision (ICD-10).
Effective July 1, 2024:
International Classification of Diseases, 10th Revision (ICD[1]10) and Other Coding Revisions to National Coverage Determinations (NCDs)--October 2024
CMS is providing a maintenance update of ICD-10 conversions and other coding updates specific to NCDs. These NCD coding changes are the result of newly available codes, coding revisions to NCDs released separately, or coding feedback received. Previous NCD coding changes appear in ICD-10 quarterly updates that can be found at:
Effective July 1, 2024:
CMS Transmittal - International Classification of Diseases, 10th Revision (ICD[1]10) and Other Coding Revisions to National Coverage Determinations (NCDs) - July 2024 Update
CMS is providing a maintenance update of ICD-10 conversions and other coding updates specific to NCDs. These NCD coding changes are the result of newly available codes, coding revisions to NCDs released separately, or coding feedback received. Previous NCD coding changes appear in ICD-10 quarterly updates that can be found at:
Effective April 1, 2024:
CMS Website - 2024 ICD-10-CM
April 1, 2024 update:
- The ICD-10-CM April 1, 2024 update addresses typographical errors. There are no new diagnosis codes being implemented.
- The files in the Downloads section below contain information on the ICD-10-CM updates effective with discharges on and after April 1, 2024.
In the Downloads section of the 2024 ICD-10-CM website, contain the following updates:
- 2024 Addendum
- 2024 Code Descriptions in Tabular Order
- 2024 Code Tables, Tabular and Index
- FY 2024 ICD-10-CM Coding Guidelines
The 2024 ICD-10-CM website is located at:
Effective April 1, 2024:
The Centers for Medicare & Medicaid Services (CMS) has updated their 2024 IC-10-PCS website on December 19, 2023. CMS is implementing 41 new procedure codes into the International Classification of Diseases, Tenth Revision, Procedure Coding System (ICD-10-PCS)
The 2024 ICD-10-PCS website is located at:
Effective April 1, 2024:
The Centers for Medicare & Medicaid Services (CMS) has issued a transmittal to implement new International Classification of Diseases, 10th Revision, Procedure Coding System (ICD-10-PCS) procedure codes to the Medicare Severity – Diagnosis Related Groups (MS-DRG) Grouper and Medicare Code Editor (MCE) version 41.1, effective for discharges on and after April 1, 2024.
The ICD-10 MS-DRG Grouper assigns each case into an MS-DRG based on the reported diagnosis and procedure codes and demographic information (age, sex, and discharge status).
The ICD-10 MCE Version 41.1 uses edits for the ICD-10 codes reported to validate correct coding on claims for discharges on or after April 1, 2024.
The ICD-10 MS-DRG Grouper software package to accommodate these new codes, Version 41.1, is effective for discharges on or after April 1, 2024. The ICD-10 MS-DRG V41.1 Grouper Software, Definitions Manual Table of Contents and the Definitions of Medicare Code Edits V41.1 manual will be available at:
Effective April 1, 2024:
CMS has provided a maintenance update to the International Code of Diseases, Tenth Revision (ICD-10) conversions and other coding updates specific to National Coverage Determinations (NCDs).
CMS issued transmittals 12318 and 12319 to provide a maintenance update of ICD-10 conversions and other coding updates specific to NCDs. These NCD coding changes are the result of newly available codes, coding revisions to NCDs released separately, or coding feedback received. Previous NCD coding changes appear in ICD-10 quarterly updates that can be found at:
Effective Jan. 1, 2024
ICD-10 & Other Coding Revisions to National Coverage Determinations: January 2024 Update
CMS issued Transmittal 12184 to provide a maintenance update of ICD-10 conversions and other coding updates specific to NCDs. These NCD coding changes are the result of newly available codes, coding revisions to NCDs released separately, or coding feedback received.
Previous NCD coding changes appear in ICD-10 quarterly updates that can be found on the
Other CRs implementing new policy NCDs can also be found there. Edits to ICD-10 and other coding updates specific to NCDs will be included in subsequent quarterly releases and individual CRs as appropriate. No policy-related changes are included with the ICD-10 quarterly updates.
Update November 10, 2023 update:
Transmittal 12184 issued August 03, 2023, is being rescinded and replaced by Transmittal 12355, dated November 9, 2023, to revise:
1. NCD 210.1 Business Requirement (BR) 13278.3 to remove FISS, add A/B MACs, and instruct MACs to adjust claims. 2. NCD 90.2, BR 13278.
2, replace CPT 81455 with CPT 81479 with associated dx codes for solid organ neoplasms, and to revise BRs 13278.4 and the implementation date.
All other information remains the same.
Effective Oct. 1, 2023:
CMS has issued instruction regarding updates to diagnosis codes required in order to allow add-on payments under the Inpatient Prospective Payment System (IPPS).
Update November 27, 2023: CMS issued Transmittal 12290
October 05, 2023, it is being rescinded and replaced by Transmittal 12380, dated November 24, 2023, to Update BR 13381.3 to remove HCPCS J7191 and J7199, and to add HCPCS J7177, J7178, and J7214. All other information remains the same.
CMS has advised the Section 20.7.3, Payment for Blood Clotting Factor Administered to Hemophilia Inpatients, of Chapter 3, Inpatient Hospital Billing, is updated with the following diagnosis codes required in order to allow add-on payments under the Inpatient Prospective Payment System (IPPS).
Add ICD-10-CM Codes (Effective 10/01/2022):
- D68.00 Von Willebrand disease, unspecified
- D68.01 Von Willebrand disease, type 1
- D68.020 Von Willebrand disease, type 2A
- D68.021 Von Willebrand disease, type 2B
- D68.022 Von Willebrand disease, type 2M
- D68.023 Von Willebrand disease, type 2N
- D68.029 Von Willebrand disease, type 2, unspecified
- D68.03 Von Willebrand disease, type 3
- D68.04 Acquired von Willebrand disease
- D68.09 Other von Willebrand disease
Terminate ICD-10-CM Code (Effective 9/30/2022):
- D68.0 Von Willebrand’s disease
Effective October 13, 2023 -
CMS announces removal of NCD 220.6.20 ending coverage with evidence development (CED) for positron emission tomography (PET) beta amyloid imaging and permitting Medicare coverage determinations for PET beta amyloid imaging to be made by the Medicare Administrative Contractors
Effective for claims with dates of service on and after October 13, 2023, CMS removed NCD 220.6.20 from Publication 100-03, the NCD Manual, ending CED and the once-in-a-lifetime requirement for PET beta amyloid imaging and permitting Medicare coverage determinations for PET beta amyloid imaging to be made by the Medicare Administrative Contractors under section 1862(a)(1)(A) of the Social Security Act.
CMS released two transmittals under 12364 that include the following:
Transmittal_12364_CP - Beginning on page 5 of this transmittal is a chart of the NCD 220.6.20 outlining descriptions, change requests and the table of content changes for the Medicare National Coverage Determinations Manual Chapter 1, Part 4 (Sections 200 – 310.1) Coverage Determinations
Transmittal_12364_NCD - Beginning on page 5 of this transmittal is the revisions made to 60.12 - Coverage for PET Scans for Dementia and Neurodegenerative Diseases
CMS Transmittals are located at the CMS website
Effective Oct. 1, 2023:
CMS has posted an update to the 2024 Conversion Table to their webpage, 2024 ICD-10-CM, on September 22, 2023.
The 2024 ICD-10-CM files contain information on the ICD-10-CM updates for FY 2024. These 2024 ICD-10-CM codes are to be used for discharges occurring from October 1, 2023 through September 30, 2024 and for patient encounters occurring from October 1, 2023 through September 30, 2024.
The Downloads section of the 2024 ICD-10-CM website, contains information on the updates to the Conversion Table effective October 1, 2023.
The 2024 ICD-10-CM website is located at
CMS has posted new documents to their webpage, 2024 ICD-10-CM
July 7, 2023 Update:
CMS updated their webpage, 2024 ICD-10-CM, with the following zip files:
- 2024 Conversion Table
- FY 2024 ICD-10-CM Coding Guidelines
July 6, 2023 Update:
CMS updated their webpage, 2024 ICD-10-CM, with the following zip files:
- Addendum
- Code Descriptions
- Code Table and Index
June 28, 2023 Update:
CMS updated their webpage, 2024 ICD-10-CM, with the following zip files:
- Addendum
- Code Table and Index
Original: CMS updated their webpage, 2024 ICD-10-CM, on June 21, 2023.
The following documents can be found on the updated
- Addendum
- Code Descriptions
- Code Table and Index
Effective Oct. 1, 2023
CMS Transmittal - International Classification of Diseases, 10th Revision (ICD[1]10) and Other Coding Revisions to National Coverage Determination (NCDs)
The Centers for Medicare & Medicaid Services (CMS) has provided a maintenance update to the International Code of Diseases, Tenth Revision (ICD-10) conversions and other coding updates specific to National Coverage Determinations (NCDs)
CMS issued Transmittal 12017 to provide a maintenance update of ICD-10 conversions and other coding updates specific to NCDs. These NCD coding changes are the result of newly available codes, coding revisions to NCDs released separately, or coding feedback received. Previous NCD coding changes appear in ICD-10 quarterly updates that can be found on the
Effective July 1, 2023
CMS has provided a maintenance update to the International Code of Diseases, Tenth Revision (ICD-10) conversions and other coding updates specific to National Coverage Determinations (NCDs).
April 12, 2023 update:
Transmittal 11884 is being rescinded and replaced by Transmittal 11952, dated, April 12, 2023, to:
- remove the A/B MACs (Part A) and FISS from BR 13070.1
and to
- revise the NCD 20.4 Implantable Automatic Defibrillators (ICDs) spreadsheet. All other information remains the same.
March 1, 2023 update:
Transmittal 11832 is being rescinded and replaced by Transmittal 11884.
(1) Business Requirement (BR) 13070.4, NCD 150.3 - delete three non-covered CPT codes added in error and remove reference to ALERT M38;
(2) (2) BR 13070.1, NCD 20.4 - clarify that C codes are only payable in the ASC setting; and
(3) NCD 220.13 spreadsheet - correct effective date of MSN 21.11 to December 31, 2022 to align with BR 13070.7. All other information remains the same.
Original Transmittal 11832
CMS issued Transmittal 11832 to provide a maintenance update of ICD-10 conversions and other coding updates specific to NCDs. These NCD coding changes are the result of newly available codes, coding revisions to NCDs released separately, or coding feedback received. Previous NCD coding changes appear in ICD-10 quarterly updates that can be viewed on the
Other CRs implementing new policy NCDs can also be found there. Edits to ICD-10 and other coding updates specific to NCDs will be included in subsequent quarterly releases and individual CRs as appropriate. No policy-related changes are included with the ICD-10 quarterly updates.
Effective April 1, 2023
CMS has issued Original Medicare instruction related to the implementation of new ICD-10- Clinical Modification (CM) codes for collection of health-related social needs (HRSNs) and also introduces new ICD-10-PCS codes to the Medicare Severity – Diagnosis Related Groups (MS-DRG) Grouper and Medicare Code Editor (MCE) version 40.1, effective for discharges on and after April 1, 2023.
New Diagnosis Codes
In an effort to better enable the collection of health-related social needs (HRSNs), defined as individual[1]level, adverse social conditions that negatively impact a person’s health or healthcare, are significant risk factors associated with worse health outcomes as well as increased healthcare utilization, the Centers for Disease Control and Prevention’s (CDC) National Center for Health Statistics (NCHS) is implementing 42 new diagnosis codes into the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM), for reporting effective April 1, 2023.
New Procedure Codes
CMS is also implementing 34 new procedure codes into the International Classification of Diseases, Tenth Revision, Procedure Coding System (ICD-10-PCS). The Index and Tabular Addenda for the new diagnosis codes will be available via the CDC website at:
The ICD-10 MS-DRG V40.1 Grouper Software, Definitions Manual Table of Contents and the Definitions of Medicare Code Edits V40.1 manual will be available at:
Effective April 1, 2023
CMS has posted new documents to their webpage, 2023 ICD-10-CM.
In an effort to better enable the collection of health-related social needs (HRSNs), defined as individual level, adverse social conditions that negatively impact a person’s health or healthcare, are significant risk factors associated with worse health outcomes as well as increased healthcare utilization, the Centers for Disease Control and Prevention’s (CDC) National Center for Health Statistics (NCHS) is implementing 42 new diagnosis codes into the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM), for reporting effective April 1, 2023.
The files in the Downloads section below contain information on the ICD-10-CM updates effective with discharges on and after April 1, 2023.
CMS also updated their webpage 2023 ICD-10-CM, with the following Zip files
- icd10cm_addenda_2023
- icd10cm_table_2023
- icd10OrderFiles
Zip files are located at the following website address:
Effective April 1, 2023
CMS has posted new documents to their webpage, 2023 ICD-10-PCS.
CMS is implementing 34 new procedure codes into the International Classification of Diseases, Tenth Revision, Procedure Coding System (ICD-10-PCS), effective April 01, 2023. Updated code files appear under the Downloads section.
CMS also updated their webpage 2023 ICD-10-PCS, with the following Zip files:
- Zip File 1 2023 Version Update Summary
- Zip File 2 2023 Code Tables and Index
- Zip File 3 2023 ICD-10-PCS Codes File
- Zip File 4 2023 ICD-10-PCS Order File (Long and Abbreviated Titles)
- Zip File 5 2023 Addendum
- Zip File 6 2023 ICD-PCS Conversion Table
Zip files are located at the following website address:
Effective April 1, 2023
CMS has provided a maintenance update to the ICD-10 conversions and other coding updates specific to NCDs.
CMS issued Transmittal 11646 to provide a maintenance update of ICD-10 conversions and other coding updates specific to NCDs. These NCD coding changes are the result of newly available codes, coding revisions to NCDs released separately, or coding feedback received. Previous NCD coding changes appear in ICD-10 quarterly updates, which can be found at:
Other CRs implementing new policy NCDs can also be found there. Edits to ICD-10 and other coding updates specific to NCDs will be included in subsequent quarterly releases and individual CRs as appropriate. No policy-related changes are included with the ICD-10 quarterly updates.
CMS has posted an updated Zip file to their webpage, 2023 ICD-10-CM, on March 1, 2023, titled, 2023 POA Exempt Codes
The updated 2023 POA Exempt Codes Zip file, which provides information on the ICD-10-CM updates effective with discharges on and after April 1, 2023, can be found in the Downloads section of this page:
The 2023 POA Exempt Codes Zip file contains the following documents:
- POA Exempt Add Codes April 2023
- POA Exempt Codes April 2023
- POA Exempt Delete Codes April 2023
- POA Exempt Revise Codes April 2023
Effective 1/1/2023
CMS has provided a maintenance update of ICD-10 conversions and other coding updates specific to NCDs.
These coding changes are the result of newly available codes, coding revisions to NCDs released separately, or coding feedback received.
Effective Jan. 1, 2023
CMS has provided a maintenance update to the International Code of Diseases, Tenth Revision (ICD-10) conversions and other coding updates specific to National Coverage Determinations (NCDs).
Update Oct. 5, 2022
Transmittal 11546, dated August 4, 2022, is being rescinded and replaced by Transmittal 11636, dated, October 5, 2022, to remove ICD-10 dx codes added in error to NCD 150.3, business requirement 12842.4, and restore ICD-10 dx C91.92 removed in error to NCD 110.23, business requirement 12842.3. All other information remains the same.
NCD spreadsheets are located at:
Effective Jan. 1, 2023
CMS has provided a maintenance update of ICD-10 conversions and other coding updates specific to NCDs. These coding changes are the result of newly available codes, coding revisions to NCDs released separately, or coding feedback received.
Transmittal 11545 dated Aug. 5, 2022, is being rescinded and replaced by Transmittal 11584, dated, Aug. 31, 2022 to (1) replace NCD 180.1 spreadsheet to align with BR 1 (CMS attached an incorrect spreadsheet), (2) replace NCD 110.24 spreadsheet to align with BR 2 (revise CARVYKTI information), and, (3) extend implementation date for NCD 20.9.1, BR 3 to Oct. 3, 2022. All other information remains the same.
Effective Oct. 1, 2022
CMS has issued instructions to implement a maintenance coding update for the coverage of IVIG for Treatment of Primary Immune Deficiency Diseases in the home.
Adding a newly established ICD-10-CM diagnosis code and remove outdated ICD-9-CM diagnosis codes
The purpose of this communication is to implement a maintenance coding update of Chapter 15, Section 50.6 of the Medicare Benefit Policy Manual (BPM), Publication (Pub) 100-02, Coverage of IVIG for Treatment of Primary Immune Deficiency Diseases in the Home. This adds a newly established ICD-10-CM diagnosis code applicable to this section of the BPM and removes outdated ICD-9-CM diagnosis codes.
New Code:
D81.82 has been added to the list of applicable diagnosis codes for coverage for IVIG for the treatment of primary immune deficiency diseases in the home
Outdated Codes (removed):
- 279.04
- 279.05
- 279.06
- 279.12
- 279.2
No policy related changes are included with this coding update. Any policy changes will continue to be effectuated separately via the current, longstanding public notice and comment rulemaking and/or National Coverage Determination (NCD) process.
Effective Oct. 1, 2022
MS issued documents for 2023 to their website, 2023 ICD-10-CM
The 2023 ICD-10-CM files contain information on the ICD-10-CM updates for FY 2023. These 2023 ICD-10-CM codes are to be used for discharges occurring from Oct. 1, 2022 through Sept. 30, 2023 and for patient encounters occurring from Oct. 1, 2022 through Sept. 30, 2023.
CMS posted the following documents to their website, 2023 ICD-10-CM:
- 2023 Addendum
- 2023 code Descriptions in Tabular order
- 2023 code Tables, Tabular and Index
- ICD 10 CM Conversion Table FY2023, effective Oct. 1, 2022
- ICD 10 CM Guidelines FY 2023
Effective July 1, 2022
CMS has provided a maintenance update to the International Code of Diseases, Tenth Revision (ICD-10) conversions and other coding updates specific to National Coverage Determinations (NCDs).
Update 04.29.2022
CMS issued Transmittal 11391, dated April 29, 2022, to rescind and replace Transmittal 11342. 2 spreadsheets have been replaced, NCD 160.18 (Vagus Nerve Stimulation (VNS)) and NCD 110.24 (CAR TCell Therapy).
All other information remains the same.
Update 04.07.2022
CMS has rescinded and replaced Transmittal 11264, dated Feb. 10, 2022 with Transmittal 11342, dated April 6, 2022, to:
- Revise BR 12606.10 instructions for NCD 110.24
- BR 12606.2, fix typo in NCD 160.18 spreadsheet ICD-10 G40.384, which should be G40.834
- Revise implementation verbiage (no changes to the actual implementation date)
All other information is the same.
Effective Jan. 1, 2022
CMS Transmittal — An Omnibus CR Covering: (1) Removal of 2 National Coverage Determination (NCDs), (2) Updates to the Medical Nutrition Therapy (MNT) Policy, and (3) Updates to the Pulmonary Rehabilitation (PR), Cardiac Rehabilitation (CR), and Intensive Cardiac Rehabilitation (ICR) Conditions of Coverage (COVID-19)
The Centers for Medicare and Medicaid Services (CMS) issued a change request to make Medicare contractors aware of the updates to remove 2 National Determination NCDs, updates to the Medical Nutritional Therapy (MNT) policy and updates to the Pulmonary Rehabilitation (PR), Cardiac Rehabilitation (CR), and Intensive Cardiac Rehabilitation (ICR) resulting from changes specified in the calendar year 2022 Physician Fee Schedule (PFS) final rule.
Update May 24, 2022
The CMS update is as follows:
Transmittal 11272, dated Feb. 18, 2022, is being rescinded and replaced by Transmittal 11426, dated, May 20, 2022 to revise chapter 32 of the IOM for Pub. 100-04. This correction does not make any revisions to the companion Pub. 100-02 or Pub. 100-03; all revisions are associated with Pub. 100-04. All other information remains the same.
Original
- Updates to Pulmonary Rehabilitation (PR), Cardiac Rehabilitation (CR) and Intensive Cardiac Rehabilitation (ICR) Conditions of Coverage
- CMS has not expanded coverage of PR further using the NCD process
- These conditions of coverage are reflected in multiple CMS program manuals
- CMS has not expanded coverage of PR further using the NCD process
- NCD Removal
- The following 2 NCDs are being removed from the NCD Manual:
- NCD 180.2 Enteral/Parenteral Nutritional Therapy
- NCD 220.6 Positron Emission Tomography (PET) Scans
- NCD 180.2 Enteral/Parenteral Nutritional Therapy
- Coverage of the above 2 NCDs revert to MAC discretion effective for claims with dates of service on and after Jan. 1, 2022
- The following 2 NCDs are being removed from the NCD Manual:
- Medical Nutrition Therapy (MNT)
- Effective Jan. 1, 2022, the regulations at 42 CFR §§ 410.130 and 410.132 will be consistent with the language of the statute and Medicare will cover MNT services with a referral by a physician (as defined in section 1861(r)(1) of the Act).
- CMS Notes: Effective Jan. 1, 2022, the regulations at 42 CFR §§410.130 and 410.132 are consistent with the language of the statute. Medicare will cover MNT services with a referral by a physician (as defined in section 1861(r)(1) of the Social Security Act). To align with the conforming changes of this regulation, the Claims Processing Manual, chapter 4, section 300, has been updated to remove the requirement that the medical nutrition therapy referral be made by the “treating” physician.
- Effective Jan. 1, 2022, the regulations at 42 CFR §§ 410.130 and 410.132 will be consistent with the language of the statute and Medicare will cover MNT services with a referral by a physician (as defined in section 1861(r)(1) of the Act).
Effective Oct. 1, 2022
CMS transmittal—ICD-10 revision and other coding revisions to NCDs
CMS has provided a maintenance update to the International Code of Diseases, Tenth Revision (ICD-10) conversions and other coding updates specific to National Coverage Determinations (NCDs).
The revisions include updates to these procedures:
- 20.31 Intensive Cardiac Rehabilitation (ICR) Programs
- 20.31.1 Intensive Cardiac Rehabilitation — Pritkin Program
- 20.31.2 Intensive Cardiac Rehabilitation — Ornish Program for Reversing Heart Disease
- 20.31.3 Intensive Cardiac Rehabilitation — Benson-Henry Program
- 90.2 Next Generation Sequencing (NGS)
- 160.18 Vague Nerve Stimulation
- 180.1 Medical Nutrition Therapy
- 270.3 Autologous Blood Derived Products for Chronic Non-Healing Wounds
View the NCD spreadsheets related to these revisions
Updates specific to these NCDs will be included in subsequent quarterly releases as necessary.
CMS clarifies that coding (as well as payment) is a separate and distinct area of the Medicare Program from coverage policy/criteria.
Effective July 1, 2022
CMS provided a maintenance update to the International Code of Diseases, Tenth Revision (ICD-10) conversions and other coding updates specific to National Coverage Determinations (NCDs), April 6, 2022 update
CMS has rescinded and replaced Transmittal 11264, dated Feb. 10, 2022 with Transmittal 11342, dated, April 6, 2022 to:
- Revise BR 12606.10 instructions for NCD 110.24
- BR 12606.2, fix typo in NCD 160.18 spreadsheet ICD-10 G40.384, which should be G40.834
- Revise implementation verbiage (no changes to the actual implementation date)
All other information remains the same.
Effective July 1, 2022
CMS transmittal—ICD-10 revision and other coding revisions to NCDs
CMS has provided a maintenance update to the ICD-10 conversions and other coding updates specific to NCDs. These NCD coding changes are the result of newly available codes, coding revisions to NCDs released separately or coding feedback received.
These revisions include updates to these procedures:
- 20.4 Implantable Automatic Defibrillators
- 20.9.1 Ventricular Assist Devices (VADs)
- 20.31 Intensive Cardiac Rehabilitation
- 20.31.1 ICR Pritikin Program
- 20.31.2 ICR Ornish Program
- 20.31.3 ICR Benson Henry
- 30.3.3 Acupuncture for Chronic Low Back Pain (cLBP)
- 110.18 Aprepitant
- 110.23 Stem Cell Transplants
- 110.24 CAR T-cell Therapy
CMS clarifies that coding (as well as payment) is a separate and distinct area of the Medicare Program from coverage policy/criteria.
These NCD coding changes result from newly available codes, coding revisions to NCDs separately or coding feedback received. Previous NCD coding changes appear in ICD-10 quarterly updates that can be found at the
Edits to ICD-10, and other coding updates specific to NCDs, will be included in subsequent quarterly releases as needed. No policy-related changes are included with these updates. Any policy-related changes to NCDs continue to be implemented via the current, long-standing NCD process.
CMS notes:
The translations from ICD-9 to ICD-10 are not consistent 1-to-1 matches, nor are all ICD-10 codes appearing in a complete General Equivalence Mappings (GEMs)* guide or other mapping guides appropriate when reviewed against individual NCD policies.
*GEMs is no longer provided by CMS as of Oct. 1, 2019.
Effective April 2022
Change request rescinding and replacing Transmittal 11068.
Transmittal 11068, dated Oct. 21, 2021, is being rescinded and replaced by Transmittal 11179, dated Jan. 12, 2022. This update adds BR 12480.10.1 to the attachment for NCD 110.24, chimeric antigen receptor therapy (CAR-T). Also, the update adds generic, unspecified procedure codes to clarify coverage and claims processing in the policy section and review the implementation date. All other information remains the same.
Effective April 2022
CMS has provided a maintenance update to the ICD-10 conversions and other coding updates specific to NCDs
These NCD coding changes result from newly available codes, coding revisions to NCDs released separately or coding feedback received.
CMS clarifies that coding (as well as payment) is a separate and distinct area of the Medicare program from coverage policy/criteria.
Effective Jan. 20, 2022
Transmittal 11171 is being rescinded and replaced with Transmittal 11214. Blood-derived products for chronic, non-healing wounds, Jan. 20, 2022 update.
This update:
- Provides clarification to the note in the Claims Processing business instructions, Pub.100-04, business requirement 12403.04-01
- Updates the title for the NCD 270.3 Blood Derived Products for Chronic Non-healing Wounds attachment
This correction does not make any revisions to the companion publication 100-03. All revisions are associated with publication 100-04. All other information remains the same.
Effective 1/12/2022: Transmittal 11119, dated Sept. 10, 2021, is being rescinded and replaced with Transmittal 11171. Blood-derived products for chronic, non-healing wounds, Jan. 12, 2022 update.
This update adds Healthcare Common Procedure Coding System (HCPCS) code G0465 to the instructions and to include additional information on HCPCS cod G0460. This correction:
- Modifies the IOM attachment for publication 100-04
- Updates the background section for publication 100-04 and BR 12403-04.1 through 12403 – 04.2.2
- Updates BR 12403- 04.3 through 12403 – 04.6
This correction does not make any revisions to the companion publication 100-03. All revisions are associated with publication 100-04. All other information remains the same.
Effective Jan. 1, 2022
Unless otherwise noted in requirements, CMS has issued a change request (CR) for a maintenance update of ICD-10 conversions and other coding updates specific to NCDs.
CMS would like to clarify that coding (as well as payment) is a separate and distinct area of the Medicare program from coverage policy/criteria.
Effective Nov. 10, 2021
Transmittal 10981, dated Sept. 8, 2021, is being rescinded and replaced with Transmittal 11119. Blood-derived products for chronic, non-healing wounds, Nov. 10, 2021 update.
The changes in this update are:
- Change Business BR 12403-04.2, BR 12403 – 04.2.1 and BR 12403 – 04.2.2 to deny
- Revise BR 12403 – 04.4.2.2 messaging
- Add BR 12403 – 042.2.1
- Remove Part A from BR 12403 -04.3 and BR 12403 – 04.3.1
- Revises verbiage in BR 12403 – 04.5 and extends the implementation date
This correction does not make any revisions to the companion publication 100-03. All revisions are associated with publication 100-04. All other information remains the same.
Effective Sept. 28, 2021
Transmittal 10963, is being rescinded and replaced with Transmittal 11025.
The changes in this update are:
- Revise spreadsheet 110.23, Stem Cell Transplants, to add back 30 diagnosis codes to the diagnosis tab removed in error
- Add override notes to BR 12399.2, NCD 110.23, Stem Cell Transplants, and 12399.5.1, NCD 160.18 VNS
- Add updated coding to BR 12399.3, NCD 110.24, CAR-T, and its associated spreadsheet, and update BRs 5 and 5.1, NCD 160.18, VNS, and its associated spreadsheet, to reflect accurate code edits
All other information remains the same.
Effective Sept. 27, 2021
CMS Transmittal — Revisions to National Coverage Determination (NCD) 240.2 (Home Use of Oxygen) and 240.2.2 (Home Oxygen Use for Cluster Headache)
The Centers for Medicare & Medicaid Services (CMS) is rescinding Transmittal 11263, dated Feb. 10, 2022, and is being replaced by Transmittal 11429, dated, May 23, 2022 to extend the implementation date to Jan. 3, 2023.
This notice is effective for claims with dates of service on or after Sept. 27, 2021:
- CMS is removing NCD 240.2.2 in the Medicare NCD Manual, ending CED, and allowing the Medicare Administrative Contractors (MACs) to make coverage determinations regarding the use of home oxygen and oxygen equipment for cluster headaches (as allowed under Subsection D of the revised NCD 240.2).
- CMS is revising NCD 240.2, Home Use of Oxygen, in the Medicare NCD Manual to nationally expand patient access to oxygen and oxygen equipment in the home.
Oxygen therapy and oxygen equipment is covered in the home for acute or chronic conditions, short or long-term, when the patient exhibits hypoxemia as defined in Section B, Nationally Covered Indications.
- Initial claims for oxygen therapy for hypoxemic patients must be based on the results of a clinical test that has been ordered and evaluated by the treating practitioner
- The modified NCD 240.2, Home Use of Oxygen identifies circumstances of non-coverage of home oxygen and oxygen equipment
- The MAC may determine that coverage of home oxygen and oxygen equipment is reasonable and necessary for patients with a medical need who are not exhibiting hypoxemia (as defined in the NCD) and who are not otherwise precluded by nationally non-covered indications described in the NCD
Effective July 1, 2021
CMS has provided a maintenance update to the International Code of Diseases, Tenth Revision (ICD-10) conversions and other coding updates specific to National Coverage Determinations (NCDs)
Update Aug. 05, 2022
CMS issued Transmittal 11545 to provide a maintenance update of ICD-10 conversions and other coding updates specific to NCD. These NCD coding changes are the result of newly available codes, coding revisions to NCDs released separately, or coding feedback received. Previous NCD coding changes appear in ICD-10 quarterly updates that can be found on the
CMS issued the following information in Transmittal 11453 on June 10, 2022:
Transmittal 10832, dated June 2, 2021, is being rescinded and replaced by Transmittal 11453, dated, June 10, 2022, to revise NCD 90.2. NGS revises business requirement 12124.2 and 12124.2.1 and its associated spreadsheet of coding by retaining all ICD-10 NOC diagnosis codes proposed for deletion effective July 1, 2022.
Effective June 2, 2021
CMS provided a maintenance update to the ICD-10 conversions and other coding updates specific to NCDs
For this update, Transmittal 10804 was rescinded and replaced by Transmittal 10832 to modify the spreadsheets for NCD 90.2, Next Generation Sequencing, and 230.9, Cryosurgery of Prostate.
NCD spreadsheets are located at the
Effective May 17, 2021
CMS provided a maintenance update to the ICD-10 conversions and other coding updates specific to NCDs
Transmittal 10624 was rescinded and replaced by Transmittal 10804 to make several changes to Business Requirement (BR) 12124.2 and NCD 90.2 Next Generation Sequencing (NGS).
Those changes are:
- Retain previously deleted codes for 1 year, and then delete following provider education
- Add 3 current procedural terminology codes and corresponding ICD-10 diagnosis codes
- Add 1 ICD-10 diagnosis code
- Delete 12 expired ICD-10 diagnosis codes
This correction also adds BR 12124.2.1 and revised the NCD 90.02 NGS spreadsheet. All other information remains the same.
For NCDs made more than 18 months ago, please visit the
- A listing of all NCDs including both pending and closed coverage determinations
- All national coverage analyses (NCAs) and final decision memos
- An index of LCDs
- Ability for users to subscribe to the CMS Coverage Listserv and receive weekly notifications when national coverage documents are updated, such as NCAs and NCDs. Listserv subscribers also receive special updates, including CMS announcements of new topics opened for national decision, decision memo postings and final technology assessment (TA) report postings
- All email coverage updates sorted by year
- A searchable NCD database
- Staff name and email links for each coverage topic so that interested individuals can send questions and provide feedback
