Your source for updates to Medicare-covered services

The Centers for Medicare & Medicaid Services (CMS) makes changes to the services that are covered by Medicare. These changes are updated via National Coverage Determinations.

CMS has issued the following national coverage determinations (NCD):

Effective June 12, 2020: Transcatheter aortic valve replacement (TAVR)

[Unless otherwise specified, the effective date is the date of service.]

The Centers for Medicare & Medicaid Services (CMS) has issued an NCD to continue covering TAVR through Coverage with Evidence Development (CED). Effective for claims with dates of service on and after June 21, 2019, plans/contractors shall continue to cover TAVR through CED when the procedure is furnished for the treatment of symptomatic aortic stenosis and according to an indication approved by the Food and Drug Administration (FDA) for use with an approved device. CED requires that each patient be entered into a qualified national registry.

For uses that are not expressly listed as an FDA-approved indication, patients must be enrolled in qualifying clinical studies. All clinical research study protocols must address prespecified research questions, adhere to standards of scientific integrity and be reviewed and approved by CMS. Approved studies will be posted to the CMS website, opens new window.

TAVR is not covered for patients in whom existing comorbidities would preclude the expected benefit from correction of the aortic stenosis.

CMS has updated the Medicare Claims Processing and National Coverage Determination manuals to align with the final decision memo for TAVR. All other information in the transmittals remains the same.

Transmittals 217 and 4546 are being rescinded and replaced by Transmittals 10179, one for each manual, dated June 10, 2020.

Effective May 8, 2020: National coverage determination (NCD) and local coverage determination (LCD) requirements during the public health emergency (PHE) for the COVID-19 pandemic

The Centers for Medicare & Medicaid Services (CMS) has finalized, on an interim basis, that required in-person encounters would not apply and that CMS will not enforce clinical indications for coverage across certain NCDs during the PHE:

  • To the extent an NCD or LCD would otherwise require a face-to-face or in-person encounter or other implied face-to-face services, those requirements would not apply.
  • CMS will not enforce the clinical indications for coverage across respiratory, home anticoagulation management, therapeutic continuous glucose monitors and infusion pump NCDs and LCDs (including articles), allowing flexibility for practitioners to care for their patients.

Effective Jan. 27, 2020: next generation sequencing (NGS) as a diagnostic laboratory test for patients with inherited breast or ovarian cancer

CMS has determined that NGS as a diagnostic laboratory test is reasonable and necessary when all of the following requirements are met:

  • Patient has breast or ovarian cancer
  • Patient has a clinical indication for germline (inherited) testing for hereditary breast or ovarian cancer
  • Patient has a risk factor for germline breast or ovarian cancer
  • Patient has not been previously tested with the same germline test using NGS for the germline genetic content

The diagnostic laboratory test using NGS must have The Food and Drug Administration (FDA)-approval or clearance and the results must be provided to the treating physician using a report template to specify treatment options.

Medicare Administrative Contractors (MACs) may determine coverage of NGS as a diagnostic laboratory test for patients with germline cancer only when the test is performed by a Clinical Laboratory Improvement Amendment (CLIA) certified laboratory and is ordered by a treating physician.


Results must also be provided to the treating physician for management of the patient, and the patient must have all of the following:

  • Any cancer diagnosis
  • A clinical indication for germline testing of hereditary cancers
  • A risk factor for germline cancer
  • Not been previously tested with the same germline test using NGS for the same germline genetic content

Effective January 21, 2020: Acupuncture for chronic low back pain (cLBP)

[Unless otherwise specified, the effective date is the date of service.]

The CMS has issued communications advising Medicare Administrative Contractors (MACs) that CMS will cover acupuncture for cLBP, effective for claims with dates of service on and after January 21, 2020. An NCD that expands coverage is also binding on Medicare Advantage organizations.

Effective for claims with dates of service on and after January 21, 2020, up to 12 visits in 90 days are covered for cLBP under the following circumstances:

  • For the purpose of this decision, cLBP is defined as:
    • Lasting 12 weeks or longer
    • Nonspecific, in that it has no identifiable systemic cause (i.e., not associated with metastatic, inflammatory, infectious, etc. disease)
    • Not associated with surgery
    • Not associated with pregnancy
  • An additional 8 sessions will be covered for those patients demonstrating an improvement. No more than 20 acupuncture treatments may be administered annually. Example: If the 1st service is performed on March 21, 2020, the next service beginning a new year cannot be performed until March 1, 2021. This means 11 full months must pass from the date of the 1st service before eligibility begins again.
  • Treatment must be discontinued if the patient is not improving or is regressing.

Physicians, physician assistants, nurse practitioners/clinical nurse specialists and auxiliary personnel may furnish acupuncture in accordance with applicable state requirements and an appropriate level of supervision.

Acupuncture is only covered for treatment of cLBP. All other types of acupuncture, including dry needling for any other condition, is still not covered by Medicare.

For NCDs made more than 18 months ago, please visit the Medicare Coverage webpage on CMS.gov, opens new window that provides:

  1. A listing of all NCDs including both pending and closed coverage determinations
  2. All national coverage analyses (NCAs) and final decision memos
  3. An index of LCDs
  4. 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
  5. All email coverage updates sorted by year
  6. A searchable NCD database
  7. Staff name and email links for each coverage topic so that interested individuals can send questions and provide feedback