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CMS Transmittals



.

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

8XXXX
90.2
Next Generation Sequencing (NGS)
8XXXX
90.2
Next Generation Sequencing (NGS)
8XXXX
90.2
Next Generation Sequencing (NGS)
8XXXX
90.2
Next Generation Sequencing (NGS)
8XXXX
90.2
Next Generation Sequencing (NGS)
8XXXX
90.2
Next Generation Sequencing (NGS)
8XXXX
90.2
Next Generation Sequencing (NGS)
8XXXX
220.13
Percutaneous Image Guided Breast Biopsy
8XXXX
220.13
Percutaneous Image Guided Breast Biopsy
8XXXX
220.13
Percutaneous Image Guided Breast Biopsy
8XXXX
220.13
Percutaneous Image Guided Breast Biopsy
8XXXX
220.13
Percutaneous Image Guided Breast Biopsy
8XXXX
220.13
Percutaneous Image Guided Breast Biopsy
8XXXX
20.9.1
Ventricular Assist Devices
8XXXX
20.9.1
Ventricular Assist Devices
8XXXX
20.9.1
Ventricular Assist Devices
8XXXX
20.9.1
Ventricular Assist Devices
8XXXX
20.7
Percutaneous Transluminal Angioplasty (PTA)
8XXXX
260.1
Adult Liver Transplantation
8XXXX
260.1
Adult Liver Transplantation
8XXXX
80.11
Vitrectomy
8XXXX
80.11
Vitrectomy
8XXXX
80.11
Vitrectomy
8XXXX
80.11
Vitrectomy
8XXXX
80.11
Vitrectomy
8XXXX
80.11
Vitrectomy
8XXXX
210.14
Lung Cancer Screening with Low Dose Computed Tomography (LDCT)
8XXXX
150.3
Bone Mineral Density
8XXXX
220.4
Mammograms
8XXXX
220.4
Mammograms
8XXXX
220.4
Mammograms
8XXXX
220.4
Mammograms
8XXXX
150.3
Bone Mineral Density
8XXXX
150.3
Bone Mineral Density
8XXXX
150.3
Bone Mineral Density
8XXXX
150.3
Bone Mineral Density
8XXXX
220.6.17
FDG PET for Head and Neck Cancers
8XXXX
220.6.17
FDG PET for Head and Neck Cancers
8XXXX
220.6.17
FDG PET for Head and Neck Cancers
8XXXX
220.6.17
FDG PET for Head and Neck Cancers
8XXXX
220.6.17
FDG PET for Head and Neck Cancers
8XXXX
220.6.17
FDG PET for Head and Neck Cancers
8XXXX
220.6.17
FDG PET for Head and Neck Cancers
8XXXX
190.23
Lipids Testing
8XXXX
190.33
Hepatitis Panel/Acute Hepatitis Panel
8XXXX
190.24
Digoxin Therapeutic Drug Assay
8XXXX
90.2
Next Generation Sequencing (NGS)
8XXXX
210.3
Multitarget Stool DNA (sDNA) Colorectal Cancer Screening Test - Cologuard
8XXXX
190.25
Alpha-fetoprotein
8XXXX
190.34
Fecal Occult Blood Test
8XXXX
190.26
Carcinoembryonic Antigen
8XXXX
190.5
Sweat Test
8XXXX
190.23
Lipids Testing
8XXXX
190.19
Collagen Crosslinks, Any Method
8XXXX
190.18
Serum Iron Studies
8XXXX
190.20
Blood Glucose Testing
8XXXX
190.20
Blood Glucose Testing
8XXXX
190.20
Blood Glucose Testing
8XXXX
190.32
Gamma Glutamyl Transferase
8XXXX
190.21
Glycated Hemoglobin/Glycated Protein
8XXXX
190.21
Glycated Hemoglobin/Glycated Protein
8XXXX
190.18
Serum Iron Studies
8XXXX
190.18
Serum Iron Studies
8XXXX
190.23
Lipids Testing
8XXXX
190.23
Lipids Testing
8XXXX
190.23
Lipids Testing
8XXXX
190.23
Lipids Testing
8XXXX
190.23
Lipids Testing
8XXXX
190.31
Prostate Specific Antigen
8XXXX
190.22
Thyroid Testing
8XXXX
190.22
Thyroid Testing
8XXXX
190.22
Thyroid Testing
8XXXX
190.18
Serum Iron Studies
8XXXX
190.23
Lipids Testing
8XXXX
190.22
Thyroid Testing
8XXXX
190.27
Human Chorionic Gonadotropin
8XXXX
190.15
Complete Blood Count
8XXXX
190.15
Complete Blood Count
8XXXX
190.15
Complete Blood Count
8XXXX
190.15
Complete Blood Count
8XXXX
190.15
Complete Blood Count
8XXXX
190.15
Complete Blood Count
8XXXX
190.15
Complete Blood Count
8XXXX
190.15
Complete Blood Count
8XXXX
190.15
Complete Blood Count
8XXXX
190.15
Complete Blood Count
8XXXX
190.15
Complete Blood Count
8XXXX
190.17
Prothrombin Time (PT)
8XXXX
190.16
Partial Thromboplastin Time (PTT)
8XXXX
190.29
Tumor Antigen by Immunoassay CA 15-3/CA 27.29
8XXXX
190.30
Tumor Antigen by Immunoassay CA 19-9
8XXXX
190.28
Tumor Antigen by Immunoassay CA 125
8XXXX
190.8
Lymphocyte Mitogen Response Assays
8XXXX
190.8
Lymphocyte Mitogen Response Assays
8XXXX
190.14
Human Immunodeficiency Virus (HIV) Testing (Diagnosis)
8XXXX
190.14
Human Immunodeficiency Virus (HIV) Testing (Diagnosis)
8XXXX
190.14
Human Immunodeficiency Virus (HIV) Testing (Diagnosis)
8XXXX
190.14
Human Immunodeficiency Virus (HIV) Testing (Diagnosis)
8XXXX
190.1
Histocompatibility Testing
8XXXX
190.1
Histocompatibility Testing
8XXXX
190.1
Histocompatibility Testing
8XXXX
190.1
Histocompatibility Testing
8XXXX
190.1
Histocompatibility Testing
8XXXX
190.1
Histocompatibility Testing
8XXXX
190.1
Histocompatibility Testing
8XXXX
190.12
Urine Culture, Bacterial
8XXXX
190.12
Urine Culture, Bacterial
8XXXX
190.14
Human Immunodeficiency Virus (HIV) Testing (Diagnosis)
8XXXX
190.14
Human Immunodeficiency Virus (HIV) Testing (Diagnosis)
8XXXX
190.14
Human Immunodeficiency Virus (HIV) Testing (Diagnosis)
8XXXX
190.14
Human Immunodeficiency Virus (HIV) Testing (Diagnosis)
8XXXX
190.13
Human Immunodeficiency Virus (HIV) Testing (Prognosis Including Monitoring)
8XXXX
190.14
Human Immunodeficiency Virus (HIV) Testing (Diagnosis)
8XXXX
190.14
Human Immunodeficiency Virus (HIV) Testing (Diagnosis)
8XXXX
190.13
Human Immunodeficiency Virus (HIV) Testing (Prognosis Including Monitoring)
8XXXX
190.3
Cytogenetic Studies
8XXXX
190.3
Cytogenetic Studies
8XXXX
190.3
Cytogenetic Studies
8XXXX
190.3
Cytogenetic Studies
8XXXX
190.3
Cytogenetic Studies
8XXXX
190.3
Cytogenetic Studies
8XXXX
190.3
Cytogenetic Studies
8XXXX
190.3
Cytogenetic Studies
8XXXX
190.3
Cytogenetic Studies
8XXXX
190.3
Cytogenetic Studies
8XXXX
190.3
Cytogenetic Studies
8XXXX
190.3
Cytogenetic Studies
8XXXX
190.3
Cytogenetic Studies
8XXXX
190.3
Cytogenetic Studies
8XXXX
190.3
Cytogenetic Studies
8XXXX
190.3
Cytogenetic Studies
8XXXX
190.3
Cytogenetic Studies
8XXXX
190.3
Cytogenetic Studies
8XXXX
190.3
Cytogenetic Studies
8XXXX
190.3
Cytogenetic Studies
8XXXX
190.3
Cytogenetic Studies
8XXXX
190.3
Cytogenetic Studies
8XXXX
190.3
Cytogenetic Studies
8XXXX
190.3
Cytogenetic Studies
8XXXX
190.3
Cytogenetic Studies
8XXXX
190.3
Cytogenetic Studies
8XXXX
190.5
Sweat Test
8XXXX
20.30
Microvolt T-Wave Alternans (MTWA)
8XXXX
20.16
Cardiac Output Monitoring by Thoracic Electrical Bioimpedance (TEB)
8XXXX
270.6
Infrared Therapy Devices
8XXXX
180.1
MNT Services
8XXXX
180.1
MNT Services
8XXXX
180.1
MNT Services
8XXXX
20.29
Hyperbaric Oxygen Therapy
8XXXX
210.4.1
Counseling to Prevent Tobacco Use
8XXXX
210.4.1
Counseling to Prevent Tobacco Use
G0102
210.1
Prostate Cancer Screening Tests
G0103
210.1
Prostate Cancer Screening Tests
G0105
210.3
Colorectal Cancer Screening Tests
G0108
40.1
Diabetes Outpatient Self-Management Training
G0109
40.1
Diabetes Outpatient Self-Management Training
G0120
210.3
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)
G0327
210.3
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
8XXXX
110.18
Aprepitant for Chemotherapy-Induced Emesis
8XXXX
110.18
Aprepitant for Chemotherapy-Induced Emesis
8XXXX
110.18
Aprepitant for Chemotherapy-Induced Emesis
8XXXX
110.18
Aprepitant for Chemotherapy-Induced Emesis
8XXXX
110.18
Aprepitant for Chemotherapy-Induced Emesis
8XXXX
110.18
Aprepitant for Chemotherapy-Induced Emesis
8XXXX
110.18
Aprepitant for Chemotherapy-Induced Emesis
8XXXX
110.18
Aprepitant for Chemotherapy-Induced Emesis
8XXXX
110.18
Aprepitant for Chemotherapy-Induced Emesis
8XXXX
110.18
Aprepitant for Chemotherapy-Induced Emesis
8XXXX
110.18
Aprepitant for Chemotherapy-Induced Emesis
8XXXX
110.18
Aprepitant for Chemotherapy-Induced Emesis
8XXXX
110.18
Aprepitant for Chemotherapy-Induced Emesis
8XXXX
110.18
Aprepitant for Chemotherapy-Induced Emesis
8XXXX
110.18
Aprepitant for Chemotherapy-Induced Emesis
8XXXX
110.18
Aprepitant for Chemotherapy-Induced Emesis
8XXXX
110.18
Aprepitant for Chemotherapy-Induced Emesis
8XXXX
110.18
Aprepitant for Chemotherapy-Induced Emesis
8XXXX
110.18
Aprepitant for Chemotherapy-Induced Emesis
8XXXX
110.18
Aprepitant for Chemotherapy-Induced Emesis
8XXXX
110.18
Aprepitant for Chemotherapy-Induced Emesis
8XXXX
110.18
Aprepitant for Chemotherapy-Induced Emesis
8XXXX
110.18
Aprepitant for Chemotherapy-Induced Emesis
8XXXX
110.18
Aprepitant for Chemotherapy-Induced Emesis
8XXXX
110.18
Aprepitant for Chemotherapy-Induced Emesis
8XXXX
110.18
Aprepitant for Chemotherapy-Induced Emesis
8XXXX
110.18
Aprepitant for Chemotherapy-Induced Emesis
8XXXX
110.18
Aprepitant for Chemotherapy-Induced Emesis
8XXXX
110.18
Aprepitant for Chemotherapy-Induced Emesis
8XXXX
110.18
Aprepitant for Chemotherapy-Induced Emesis
8XXXX
110.18
Aprepitant for Chemotherapy-Induced Emesis
8XXXX
110.18
Aprepitant for Chemotherapy-Induced Emesis
8XXXX
110.18
Aprepitant for Chemotherapy-Induced Emesis
8XXXX
110.18
Aprepitant for Chemotherapy-Induced Emesis
8XXXX
110.18
Aprepitant for Chemotherapy-Induced Emesis
8XXXX
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

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