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section string | title string | version string | effective_date string | implementation_date string | ncd_id string | source_url string | item_service_description string | indications_and_limitations string | cross_reference string | other string |
|---|---|---|---|---|---|---|---|---|---|---|
240.2 | Home Use of Oxygen | 2 | 2021-09-27 | 2023-01-03 | 169 | https://www.cms.gov/medicare-coverage-database/view/ncd.aspx?ncdid=169&ncdver=2 | A. General
When used in the home, oxygen and oxygen equipment can make meaningful contributions to the treatment of patients with both acute and chronic conditions who require the medical gas on either a short- or long-term basis. | B. Nationally Covered Indications
Oxygen therapy and oxygen equipment is covered in the home for acute or chronic conditions, short- or long- term, when the patient exhibits hypoxemia as defined below.
Initial claims for oxygen therapy for hypoxemic patients must be based on the results of a clinical test that has be... | ||
240.4 | Continuous Positive Airway Pressure (CPAP) Therapy For Obstructive Sleep Apnea (OSA) | 3 | 2008-03-13 | 2008-08-04 | 226 | https://www.cms.gov/medicare-coverage-database/view/ncd.aspx?ncdid=226&ncdver=3 | A. General
Continuous Positive Airway Pressure (CPAP) is a non-invasive technique for providing single levels of air pressure from a flow generator, via a nose mask, through the nares. The purpose is to prevent the collapse of the oropharyngeal walls and the obstruction of airflow during sleep, which occurs in obstruc... | B. Nationally Covered Indications
Effective for claims with dates of service on and after March 13, 2008, the Centers for Medicare & Medicaid Services (CMS) determines that CPAP therapy when used in adult patients with OSA is considered reasonable and necessary under the following situations:
- The use of CPAP is cov... | See Section 280.1, Durable Medical Equipment Reference List
CED page | |
20.4 | Implantable Cardioverter Defibrillators (ICDs) | 5 | 2023-07-31 | 2023-07-31 | 110 | https://www.cms.gov/medicare-coverage-database/view/ncd.aspx?ncdid=110&ncdver=5 | A. General
An implantable cardioverter defibrillator (ICD) is an electronic device designed to diagnose and treat life-threatening ventricular tachyarrhythmias. | B. Nationally Covered Indications
Effective for services performed on or after February 15, 2018 CMS has determined that the evidence is sufficient to conclude that the use of ICDs, (also referred to as defibrillators) is reasonable and necessary:
- Patients with a personal history of sustained ventricular tachyarrhy... | ||
210.14 | Lung Cancer Screening with Low Dose Computed Tomography (LDCT) | 2 | 2022-02-10 | 2022-10-03 | 364 | https://www.cms.gov/medicare-coverage-database/view/ncd.aspx?ncdid=364&ncdver=2 | A. General
Lung cancer is the third most common cancer and the leading cause of cancer deaths in the United States. Cancer of the lung and bronchus accounted for over 130,000 deaths in 2021 (more than the total number of estimated deaths from colon, breast and prostate cancer combined) with a median age at death of 72... | B. Nationally Covered Indications
Effective for claims with dates of service on or after February 10, 2022, CMS has determined that the evidence is sufficient to cover, under Medicare Part B, a lung cancer screening counseling and shared decision-making visit, and for appropriate beneficiaries, annual screening for lu... | ||
100.1 | Bariatric Surgery for Treatment of Co-Morbid Conditions Related to Morbid Obesity | 5 | 2013-09-24 | 2013-12-17 | 57 | https://www.cms.gov/medicare-coverage-database/view/ncd.aspx?ncdid=57&ncdver=5 | Please note, sections 40.5, 100.8, 100.11, and 100.14 have been removed from the National Coverage Determination (NCD) Manual and incorporated into NCD 100.1
A. General
Obesity may be caused by medical conditions such as hypothyroidism, Cushing's disease, and hypothalamic lesions, or can aggravate a number of cardiac... | B. Nationally Covered Indications
Effective for services performed on and after February 21, 2006, Open and laparoscopic Roux-en-Y gastric bypass (RYGBP), open and laparoscopic Biliopancreatic Diversion with Duodenal Switch (BPD/DS) or Gastric Reduction Duodenal Switch (BPD/GRDS), and laparoscopic adjustable gastric b... | ||
210.3 | Colorectal Cancer Screening Tests | 8 | 2026-06-08 | 2027-01-04 | 281 | https://www.cms.gov/medicare-coverage-database/view/ncd.aspx?ncdid=281&ncdver=8 | A. General
Sections 1861(s)(2)(R) and 1861(pp) of the Social Security Act (the Act) and regulations at 42 CFR 410.37 authorize Medicare coverage for screening colorectal cancer tests under Medicare Part B. The statute and regulations authorize the Secretary to add other tests and procedures (and modifications to tests... | B. Nationally Covered Indications
1. Fecal Occult Blood Tests (FOBT) (effective January 1, 2004)
Fecal occult blood tests (FOBTs) are generally divided into two types: immunoassay and guaiac types. Immunoassay (or immunochemical) fecal occult blood tests (iFOBT) use “antibodies directed against human globin epitopes.... | Also see NCD for Fecal Occult Blood Test (§190.34). | |
30.3.3 | Acupuncture for Chronic Lower Back Pain (cLBP) | 1 | 2020-01-21 | 2020-06-24 | 373 | https://www.cms.gov/medicare-coverage-database/view/ncd.aspx?ncdid=373&ncdver=1 | A. General
Acupuncture is the selection and manipulation of specific acupuncture points by a variety of needling and non-needling techniques. | B. Nationally Covered Indications
Effective for services performed on or after January 21, 2020, CMS will cover acupuncture for Medicare patients with chronic Lower Back Pain (cLBP). Up to 12 visits in 90 days are covered for Medicare beneficiaries under the following circumstance:
- For the purpose of this decision,... | ||
190.11 | Home Prothrombin Time/International Normalized Ratio (PT/INR) Monitoring for Anticoagulation Management | 2 | 2008-03-19 | 2008-08-25 | 269 | https://www.cms.gov/medicare-coverage-database/view/ncd.aspx?ncdid=269&ncdver=2 | A. General
Use of the International Normalized Ratio (INR) or prothrombin time (PT) - standard measurement for reporting the blood's clotting time - allows physicians to determine the level of anticoagulation in a patient independent of the laboratory reagents used. The INR is the ratio of the patient's PT (extrinsic ... | B. Nationally Covered Indications
For services furnished on or after March 19, 2008, Medicare will cover for the use of home PT/INR monitoring forchronic, oral anticoagulation management for patients with mechanical heart valves, chronic atrial fibrillation, or venous thromboembolism (inclusive of deep venous thrombos... | ||
110.21 | Erythropoiesis Stimulating Agents (ESAs) in Cancer and Related Neoplastic Conditions | 1 | 2007-07-30 | 2008-04-07 | 322 | https://www.cms.gov/medicare-coverage-database/view/ncd.aspx?ncdid=322&ncdver=1 | A. General
Erythropoiesis stimulating agents (ESAs) stimulate the bone marrow to make more red blood cells and are United States Food and Drug Administration (FDA) approved for use in reducing the need for blood transfusion in patients with specific clinical indications. The FDA has issued alerts and warnings for ESAs... | B. Nationally Covered Indications
ESA treatment for the anemia secondary to myelosuppressive anticancer chemotherapy in solid tumors, multiple myeloma, lymphoma, and lymphocytic leukemia is only reasonable and necessary under the following specified conditions:
- The hemoglobin level immediately prior to initiation o... | ||
210.13 | Screening for Hepatitis C Virus (HCV) in Adults | 1 | 2014-06-02 | 2015-01-05 | 361 | https://www.cms.gov/medicare-coverage-database/view/ncd.aspx?ncdid=361&ncdver=1 | A. General
Hepatitis C Virus (HCV) is an infection that attacks the liver and leads to inflammation. The infection is often asymptomatic and can go undiagnosed for decades. It is difficult for the human immune system to eliminate the HCV and it is a major cause of chronic liver disease. The presence of HCV in the live... | B. Nationally Covered Indications
Effective for services performed on or after June 2, 2014, CMS has determined the following:
The evidence is adequate to conclude that screening for HCV, consistent with the grade B recommendations by the USPSTF, is reasonable and necessary for the prevention or early detection of an... |
ncd-prior-auth
The text of ten Medicare National Coverage Determinations (NCDs), verbatim, for the prior-auth environment: the
policies a physician reviewer applies to a prior authorization request.
Source
Centers for Medicare & Medicaid Services (CMS), Medicare Coverage Database, "Current NCD Data" export.
- Downloads page: https://www.cms.gov/medicare-coverage-database/downloads/downloads.aspx
- File: https://downloads.cms.gov/medicare-coverage-database/downloads/exports/ncd.zip (
ncd.zip, which holdsncd_csv.zip/ncd_trkg.csv) - SHA-256 of
ncd.zip:07b8716220e122b687ec871639f1945ef49ae99bea2f3a3184fb0cc4f1ed7aff - Downloaded: 2026-10-14T15:07:32+00:00 (1,282,836 bytes)
Licence
NCDs are works of the United States Government (Centers for Medicare & Medicaid Services), which are not subject to copyright in the United States (17 U.S.C. § 105). CMS states on its website: "CMS.gov is the official website of the Centers for Medicare & Medicaid Services (CMS), an operating division of the U.S. Department of Health & Human Services (HHS). It is a public domain web site." (https://www.cms.gov/about-cms/web-policies-important-links/about-website/link-to-us).
The Medicare Coverage Database downloads page shows a click-through licence for the AMA Current Procedural
Terminology (CPT) and the ADA Current Dental Terminology (CDT) code sets that some coverage documents embed. The
export flags such NCDs (NCD_AMA); every NCD in this dataset carries NCD_AMA = False and no CDT content, and no
CPT or CDT code set is included. No other restriction applies.
What is in it
data/ncd.parquet, one row per NCD, every column a string:
| column | content |
|---|---|
section |
the NCD manual section (for example 240.2) |
title |
the NCD title |
version |
the version number kept (the latest version that is not terminated at download time) |
effective_date, implementation_date |
from the export |
ncd_id |
the Medicare Coverage Database id |
source_url |
the NCD's page on the Medicare Coverage Database |
item_service_description |
section A of the NCD, plain text |
indications_and_limitations |
sections B, C and D of the NCD (covered, non-covered, other), plain text |
cross_reference, other |
the remaining text fields, plain text |
The HTML of the export is turned into plain text: paragraphs and list items on their own lines (list items get a leading dash), tags dropped, entities decoded. No word of the NCD text is changed.
| section | title | version | effective | implementation | source |
|---|---|---|---|---|---|
| 240.2 | Home Use of Oxygen | 2 | 2021-09-27 | 2023-01-03 | view |
| 240.4 | Continuous Positive Airway Pressure (CPAP) Therapy For Obstructive Sleep Apnea (OSA) | 3 | 2008-03-13 | 2008-08-04 | view |
| 20.4 | Implantable Cardioverter Defibrillators (ICDs) | 5 | 2023-07-31 | 2023-07-31 | view |
| 210.14 | Lung Cancer Screening with Low Dose Computed Tomography (LDCT) | 2 | 2022-02-10 | 2022-10-03 | view |
| 100.1 | Bariatric Surgery for Treatment of Co-Morbid Conditions Related to Morbid Obesity | 5 | 2013-09-24 | 2013-12-17 | view |
| 210.3 | Colorectal Cancer Screening Tests | 8 | 2026-06-08 | 2027-01-04 | view |
| 30.3.3 | Acupuncture for Chronic Lower Back Pain (cLBP) | 1 | 2020-01-21 | 2020-06-24 | view |
| 190.11 | Home Prothrombin Time/International Normalized Ratio (PT/INR) Monitoring for Anticoagulation Management | 2 | 2008-03-19 | 2008-08-25 | view |
| 110.21 | Erythropoiesis Stimulating Agents (ESAs) in Cancer and Related Neoplastic Conditions | 1 | 2007-07-30 | 2008-04-07 | view |
| 210.13 | Screening for Hepatitis C Virus (HCV) in Adults | 1 | 2014-06-02 | 2015-01-05 | view |
Citation
Centers for Medicare & Medicaid Services. Medicare Coverage Database, National Coverage Determinations. https://www.cms.gov/medicare-coverage-database/
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