Before deciding whether Medicare should cover a particular item (such as a brace or a hearing aid) or a service (such as therapy or screenings), the federal government conducts a comprehensive review process, and occasionally Congress may pass a law requiring coverage of a particular item or service. After coverage determinations or decisions are authorized, Medicare coverage is modified and Medicare carriers and other contractors (including Medicare Advantage organizations) coordinate their processes to fulfill these new coverage obligations. The formal name for these decisions which allow, limit, or exclude Medicare coverage is known as a National Coverage Determination (NCD). Coverage guidelines and effective dates are defined by Medicare or other rulemaking authority.
The chart below lists recently announced National Coverage Determinations. It will be updated periodically. You will also find related listings updated periodically at www.medicare.gov.
|
Effective Date |
NCD description |
|---|---|
|
June 27, 2012 |
Medicare contractors may cover a weight-reduction surgical procedure called Laparoscopic Sleeve Gastrostomy (LSG). This will be in addition to the coverage for Bariatric Surgery for the treatment of morbid obesity, as defined by Medicare. |
|
June 21, 2012 |
Medicare covers liver transplantation for patients with certain malignancies in carefully selected cases. |
|
June 8, 2012 |
Medicare will only allow coverage of Transcutaneous Electrical Nerve Stimulators (TENS) for Chronic Low Back Pain (CLBP) under certain conditions. |
|
May 1, 2012 |
Medicare covers Transcatheter Aortic Valve Replacement (TAVR - a new technology for use in treating certain patients with aortic stenosis) under certain conditions. |
|
April 30, 2012 |
CMS covers extracorporeal photopheresis for the treatment of bronchiolitis obliterans syndrome (BOS) following lung allograft transplantation if it is a part of a clinical research study. |
|
November 29, 2011 |
Medicare covers certain screenings and counseling for obesity. |
|
November 8, 2011 |
Medicare covers intensive behavioral therapy for cardiovascular disease (CVD) |
|
November 8, 2011 |
Medicare covers screening for Sexually Transmitted Infections (STI) and high intensity behavioral counseling to prevent STI |
|
October 14, 2011 |
Medicare covers certain screenings for depression in adults. |
|
October 14, 2011 |
Medicare covers certain screenings & behavioral counseling interventions in primary care to reduce alcohol misuse. |
|
July 7, 2011 |
Medicare covers Magnetic Resonance Imaging (MRI) with FDA Approved implanted permanent pacemaker. |
|
June 30, 2011 |
Medicare covers autologous cellular immunotherapy treatment with sipuleuce-T PROVENGE® |
