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Transmittal 11865 issued February 16, 2023, is being rescinded and replaced by Transmittal 12299, dated October 12, 2023, to provide clarifications on CMS policy and related claims processing instructions for our approach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
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 April. 1, 2025
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 January 2025
International Classification of Diseases, 10th Revision (ICD-10) and Other Coding Revisions to National Coverage Determinations (NCDs) and Update to the Appropriate Use Criteria (AUC) Program
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:
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:
- NCD 210.1 Business Requirement (BR) 13278.3 to remove FISS, add A/B MACs, and instruct MACs to adjust claims.
- 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 attached Zip Files contain the following documents that appear on the updated webpage:
- Addendum
- Code Descriptions
- Code Table and Index
All files can be found in the Downloads section of this page:
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 at:
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 found at:
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:
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 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 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.
Effective date of January 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.
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
