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2018

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National Coverage Determinations
The below list contains NCD policies that require specific one-to-one diagnosis code requirements for Medicare medical necessity checking. This list is not exhaustive and does not contain policies that may only include frequency limitations, complex secondary diagnosis code requirements or other requirements not specifically related to CPT to Diagnosis code edits. Please see the National Coverage Determinations (NCDs) by Chapter/Section Index for the complete list of current CMS National Coverage Policies.

Recent Lab NCD Manuals

To use the diagnosis code requirements in these policies for medical necessity checking in your order entry system, please see CodeMap Medical Necessity Data Files

Procedure
Policy Number
Title

19081 220.13 Percutaneous Image Guided Breast Biopsy
19082 220.13 Percutaneous Image Guided Breast Biopsy
19083 220.13 Percutaneous Image Guided Breast Biopsy
19084 220.13 Percutaneous Image Guided Breast Biopsy
19085 220.13 Percutaneous Image Guided Breast Biopsy
19086 220.13 Percutaneous Image Guided Breast Biopsy
33979 20.9.1 Ventricular Assist Devices
33980 20.9.1 Ventricular Assist Devices
33982 20.9.1 Ventricular Assist Devices
33983 20.9.1 Ventricular Assist Devices
36516 20.5 Extracorporeal Immunoadsorption Using Protein A Columns
37215 20.7 Percutaneous Transluminal Angioplasty (PTA)
47135 260.1 Adult Liver Transplantation
47399 260.1 Adult Liver Transplantation
67036 80.11 Vitrectomy
67039 80.11 Vitrectomy
67040 80.11 Vitrectomy
67041 80.11 Vitrectomy
67042 80.11 Vitrectomy
67043 80.11 Vitrectomy
76977 150.3 Bone Mineral Density
77063 220.4 Mammograms
77065 220.4 Mammograms
77066 220.4 Mammograms
77067 220.4 Mammograms
77078 150.3 Bone Mineral Density
77080 150.3 Bone Mineral Density
77081 150.3 Bone Mineral Density
77085 150.3 Bone Mineral Density
78608 220.6.17 FDG PET for Head and Neck Cancers
78811 220.6.17 FDG PET for Head and Neck Cancers
78812 220.6.17 FDG PET for Head and Neck Cancers
78813 220.6.17 FDG PET for Head and Neck Cancers
78814 220.6.17 FDG PET for Head and Neck Cancers
78815 220.6.17 FDG PET for Head and Neck Cancers
78816 220.6.17 FDG PET for Head and Neck Cancers
80061 190.23 Lipids Testing
80074 190.33 Hepatitis Panel/Acute Hepatitis Panel
80162 190.24 Digoxin Therapeutic Drug Assay
81528 210.3 Multitarget Stool DNA (sDNA) Colorectal Cancer Screening Test - Cologuard
82105 190.25 Alpha-fetoprotein
82272 190.34 Fecal Occult Blood Test
82378 190.26 Carcinoembryonic Antigen
82438 190.5 Sweat Test
82465 190.23 Lipids Testing
82523 190.19 Collagen Crosslinks, Any Method
82728 190.18 Serum Iron Studies
82947 190.20 Blood Glucose Testing
82948 190.20 Blood Glucose Testing
82962 190.20 Blood Glucose Testing
82977 190.32 Gamma Glutamyl Transferase
82985 190.21 Glycated Hemoglobin/Glycated Protein
83036 190.21 Glycated Hemoglobin/Glycated Protein
83540 190.18 Serum Iron Studies
83550 190.18 Serum Iron Studies
83700 190.23 Lipids Testing
83701 190.23 Lipids Testing
83704 190.23 Lipids Testing
83718 190.23 Lipids Testing
83721 190.23 Lipids Testing
84153 190.31 Prostate Specific Antigen
84436 190.22 Thyroid Testing
84439 190.22 Thyroid Testing
84443 190.22 Thyroid Testing
84466 190.18 Serum Iron Studies
84478 190.23 Lipids Testing
84479 190.22 Thyroid Testing
84702 190.27 Human Chorionic Gonadotropin
85004 190.15 Complete Blood Count
85007 190.15 Complete Blood Count
85008 190.15 Complete Blood Count
85013 190.15 Complete Blood Count
85014 190.15 Complete Blood Count
85018 190.15 Complete Blood Count
85025 190.15 Complete Blood Count
85027 190.15 Complete Blood Count
85032 190.15 Complete Blood Count
85048 190.15 Complete Blood Count
85049 190.15 Complete Blood Count
85610 190.17 Prothrombin Time (PT)
85730 190.16 Partial Thromboplastin Time (PTT)
86300 190.29 Tumor Antigen by Immunoassay CA 15-3/CA 27.29
86301 190.30 Tumor Antigen by Immunoassay CA 19-9
86304 190.28 Tumor Antigen by Immunoassay CA 125
86352 190.8 Lymphocyte Mitogen Response Assays
86353 190.8 Lymphocyte Mitogen Response Assays
86689 190.14 Human Immunodeficiency Virus (HIV) Testing (Diagnosis)
86701 190.14 Human Immunodeficiency Virus (HIV) Testing (Diagnosis)
86702 190.14 Human Immunodeficiency Virus (HIV) Testing (Diagnosis)
86703 190.14 Human Immunodeficiency Virus (HIV) Testing (Diagnosis)
86812 190.1 Histocompatibility Testing
86813 190.1 Histocompatibility Testing
86816 190.1 Histocompatibility Testing
86817 190.1 Histocompatibility Testing
86821 190.1 Histocompatibility Testing
86825 190.1 Histocompatibility Testing
86826 190.1 Histocompatibility Testing
87086 190.12 Urine Culture, Bacterial
87088 190.12 Urine Culture, Bacterial
87390 190.14 Human Immunodeficiency Virus (HIV) Testing (Diagnosis)
87391 190.14 Human Immunodeficiency Virus (HIV) Testing (Diagnosis)
87534 190.14 Human Immunodeficiency Virus (HIV) Testing (Diagnosis)
87535 190.14 Human Immunodeficiency Virus (HIV) Testing (Diagnosis)
87536 190.13 Human Immunodeficiency Virus (HIV) Testing (Prognosis Including Monitoring)
87537 190.14 Human Immunodeficiency Virus (HIV) Testing (Diagnosis)
87538 190.14 Human Immunodeficiency Virus (HIV) Testing (Diagnosis)
87539 190.13 Human Immunodeficiency Virus (HIV) Testing (Prognosis Including Monitoring)
88230 190.3 Cytogenetic Studies
88233 190.3 Cytogenetic Studies
88235 190.3 Cytogenetic Studies
88237 190.3 Cytogenetic Studies
88239 190.3 Cytogenetic Studies
88240 190.3 Cytogenetic Studies
88241 190.3 Cytogenetic Studies
88245 190.3 Cytogenetic Studies
88248 190.3 Cytogenetic Studies
88249 190.3 Cytogenetic Studies
88261 190.3 Cytogenetic Studies
88262 190.3 Cytogenetic Studies
88263 190.3 Cytogenetic Studies
88264 190.3 Cytogenetic Studies
88267 190.3 Cytogenetic Studies
88269 190.3 Cytogenetic Studies
88271 190.3 Cytogenetic Studies
88272 190.3 Cytogenetic Studies
88273 190.3 Cytogenetic Studies
88274 190.3 Cytogenetic Studies
88275 190.3 Cytogenetic Studies
88280 190.3 Cytogenetic Studies
88283 190.3 Cytogenetic Studies
88285 190.3 Cytogenetic Studies
88289 190.3 Cytogenetic Studies
88291 190.3 Cytogenetic Studies
89230 190.5 Sweat Test
93025 20.30 Microvolt T-Wave Alternans (MTWA)
93701 20.16 Cardiac Output Monitoring by Thoracic Electrical Bioimpedance (TEB)
97026 270.6 Infrared Therapy Devices
97802 180.1 MNT Services
97803 180.1 MNT Services
97804 180.1 MNT Services
99183 20.29 Hyperbaric Oxygen Therapy
99406 210.4.1 Counseling to Prevent Tobacco Use
99407 210.4.1 Counseling to Prevent Tobacco Use
G0102 210.1 Prostate Cancer Screening Tests
G0103 210.1 Prostate Cancer Screening Tests
G0108 40.1 Diabetes Outpatient Self-Management Training
G0109 40.1 Diabetes Outpatient Self-Management Training
G0123 210.2 Screening Pap Smears and Pelvic Examinations for Early Detection of Cervical or Vaginal Cancer
G0124 210.2 Screening Pap Smears and Pelvic Examinations for Early Detection of Cervical or Vaginal Cancer
G0130 150.3 Bone Mineral Density
G0141 210.2 Screening Pap Smears and Pelvic Examinations for Early Detection of Cervical or Vaginal Cancer
G0143 210.2 Screening Pap Smears and Pelvic Examinations for Early Detection of Cervical or Vaginal Cancer
G0144 210.2 Screening Pap Smears and Pelvic Examinations for Early Detection of Cervical or Vaginal Cancer
G0145 210.2 Screening Pap Smears and Pelvic Examinations for Early Detection of Cervical or Vaginal Cancer
G0147 210.2 Screening Pap Smears and Pelvic Examinations for Early Detection of Cervical or Vaginal Cancer
G0148 210.2 Screening Pap Smears and Pelvic Examinations for Early Detection of Cervical or Vaginal Cancer
G0202 220.4 Mammograms
G0204 220.4 Mammograms
G0206 220.4 Mammograms
G0248 190.11 Home Prothrombin Time INR Monitoring for Anticoagulation Management
G0249 190.11 Home Prothrombin Time INR Monitoring for Anticoagulation Management
G0250 190.11 Home Prothrombin Time INR Monitoring for Anticoagulation Management
G0270 180.1 MNT Services
G0271 180.1 MNT Services
G0277 20.29 Hyperbaric Oxygen Therapy
G0279 220.4 Mammograms
G0281 270.1 Electrical Stimulation (ES) and Electromagnetic Therapy for the Treatment of Wounds
G0296 210.14 Lung Cancer Screening with Low Dose Computed Tomography (LDCT)
G0297 210.14 Lung Cancer Screening with Low Dose Computed Tomography (LDCT)
G0329 270.1 Electrical Stimulation (ES) and Electromagnetic Therapy for the Treatment of Wounds
G0432 210.7 HIV Screening
G0433 210.7 HIV Screening
G0435 210.7 HIV Screening
G0460 270.3 Blood Derived Products for Chronic Non-healing Wounds
G0464 210.3 Multitarget Stool DNA (sDNA) Colorectal Cancer Screening Test - Cologuard
G0472 210.13 Screening for Hepatitis C Virus in Adults
G0475 210.7 HIV Screening
G0476 210.2.1 HPV screening
G0499 210.6 Screening for Hepatitis B Virus (HBV) Infection
J0202 110.18 Aprepitant for Chemotherapy-Induced Emesis
J8501 110.18 Aprepitant for Chemotherapy-Induced Emesis
J8540 110.18 Aprepitant for Chemotherapy-Induced Emesis
J8655 110.18 Aprepitant for Chemotherapy-Induced Emesis
J8670 110.18 Aprepitant for Chemotherapy-Induced Emesis
J9000 110.18 Aprepitant for Chemotherapy-Induced Emesis
J9025 110.18 Aprepitant for Chemotherapy-Induced Emesis
J9027 110.18 Aprepitant for Chemotherapy-Induced Emesis
J9033 110.18 Aprepitant for Chemotherapy-Induced Emesis
J9045 110.18 Aprepitant for Chemotherapy-Induced Emesis
J9050 110.18 Aprepitant for Chemotherapy-Induced Emesis
J9060 110.18 Aprepitant for Chemotherapy-Induced Emesis
J9070 110.18 Aprepitant for Chemotherapy-Induced Emesis
J9100 110.18 Aprepitant for Chemotherapy-Induced Emesis
J9130 110.18 Aprepitant for Chemotherapy-Induced Emesis
J9151 110.18 Aprepitant for Chemotherapy-Induced Emesis
J9178 110.18 Aprepitant for Chemotherapy-Induced Emesis
J9206 110.18 Aprepitant for Chemotherapy-Induced Emesis
J9208 110.18 Aprepitant for Chemotherapy-Induced Emesis
J9211 110.18 Aprepitant for Chemotherapy-Induced Emesis
J9230 110.18 Aprepitant for Chemotherapy-Induced Emesis
J9263 110.18 Aprepitant for Chemotherapy-Induced Emesis
J9320 110.18 Aprepitant for Chemotherapy-Induced Emesis
P3000 210.2 Screening Pap Smears and Pelvic Examinations for Early Detection of Cervical or Vaginal Cancer
P3001 210.2 Screening Pap Smears and Pelvic Examinations for Early Detection of Cervical or Vaginal Cancer
Q0091 210.2 Screening Pap Smears and Pelvic Examinations for Early Detection of Cervical or Vaginal Cancer
Q0162 110.18 Aprepitant for Chemotherapy-Induced Emesis
Q0166 110.18 Aprepitant for Chemotherapy-Induced Emesis
Q0180 110.18 Aprepitant for Chemotherapy-Induced Emesis
Q0181 110.18 Aprepitant for Chemotherapy-Induced Emesis
S0178 110.18 Aprepitant for Chemotherapy-Induced Emesis

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