What types of policy changes does Medicare/CMS - NCD issue?

Medicare/CMS - NCD regularly publishes coverage updates including prior authorization requirement changes, billing code additions or deletions, plan-type coverage modifications, and clinical policy revisions. PolicyChanges.app monitors these notices and summarizes the impact for providers.

How often does Medicare/CMS - NCD update its policies?

Medicare/CMS - NCD typically releases policy bulletins on a rolling basis throughout the year. Our system checks for new updates daily and adds them to this feed as soon as they are identified.

How many Medicare/CMS - NCD policy changes are tracked here?

This page currently tracks 17 documented Medicare/CMS - NCD policy changes. New items are added as they are identified.

What should I do when Medicare/CMS - NCD changes a prior authorization policy?

Review each change's effective date and action-required notes. Update your billing and clinical workflows before the effective date to avoid claim denials. Each policy detail page on PolicyChanges.app includes a plain-English summary and action items.

Medicare/CMS - NCD Policy Changes & Prior Auth Updates

We track 17 documented policy changes from Medicare/CMS - NCD. Each entry includes an AI-generated plain-English summary, effective date, affected billing codes, and a direct link to the original Medicare/CMS - NCD notice. Use the related links below to narrow results by specialty or state, or sign up for a free daily alert to receive new Medicare/CMS - NCD updates automatically.

Medium impact
Xenon Scan - RETIRED
Medicare/CMS - NCD·Effective Jun 15, 2026
The Xenon Scan National Coverage Determination has been officially retired by CMS. This means Medicare will no longer provide coverage for xenon scanning procedures, and any related billing codes are no longer valid for Medicare claims.
Medium impact
Vagus Nerve Stimulation (VNS)
Medicare/CMS - NCD·Effective Apr 30, 2026
This is a National Coverage Determination for Vagus Nerve Stimulation (VNS) therapy from Medicare. However, the policy content provided contains only header information without the actual coverage details, billing codes, or specific requirements.
Medium impact
Transcatheter Tricuspid Valve Replacement (TTVR)
Medicare/CMS - NCD·Effective Jun 2, 2026
Medicare has established a new National Coverage Determination (NCD 20.37) for Transcatheter Tricuspid Valve Replacement (TTVR), defining coverage criteria for this cardiac procedure. This creates new billing guidelines and coverage requirements for TTVR procedures under Medicare.
Medium impact
Transcatheter Edge-to-Edge Repair for Tricuspid Valve Regurgitation (T-TEER)
Medicare/CMS - NCD·Effective Jun 2, 2026
CMS has issued a new National Coverage Determination (NCD 20.38) for Transcatheter Edge-to-Edge Repair for Tricuspid Valve Regurgitation (T-TEER). This establishes Medicare coverage criteria for this cardiac procedure, which may require specific documentation and prior authorization requirements.
Medium impact
Screening for Sexually Transmitted Infections (STIs) and High-Intensity Behavioral Counseling (HIBC) to Prevent STIs
Medicare/CMS - NCD·Effective Apr 30, 2026
Medicare has updated National Coverage Determination 210.10 regarding screening for sexually transmitted infections (STIs) and high-intensity behavioral counseling to prevent STIs. This policy affects coverage and billing for STI screening services and preventive counseling under Medicare.
Medium impact
Screening for Hepatitis C Virus (HCV) in Adults
Medicare/CMS - NCD·Effective Apr 7, 2026
This is a National Coverage Determination for Hepatitis C Virus screening in adults under Medicare. However, the policy content provided only contains metadata and header information without the actual coverage criteria, billing codes, or specific requirements.
Medium impact
Renal Denervation (RDN) for Uncontrolled Hypertension
Medicare/CMS - NCD·Effective Mar 24, 2026
CMS has issued a new National Coverage Determination (NCD 20.40) for Renal Denervation (RDN) procedures used to treat uncontrolled hypertension. This establishes Medicare coverage criteria for this specialized cardiovascular procedure.
Medium impact
Pre-Exposure Prophylaxis (PrEP) for Human Immunodeficiency Virus (HIV) Prevention
Medicare/CMS - NCD·Effective Apr 7, 2026
Medicare has issued a new National Coverage Determination (NCD 210.15) for Pre-Exposure Prophylaxis (PrEP) for HIV Prevention. This establishes coverage criteria and billing guidelines for PrEP services under Medicare, which may affect primary care and infectious disease practices that provide HIV prevention services.
Medium impact
Positron Emission Tomography (FDG) for Oncologic Conditions
Medicare/CMS - NCD·Effective Apr 30, 2026
This is a National Coverage Determination for Positron Emission Tomography (FDG) for oncologic conditions, updated April 30, 2026. Without the full policy text, specific changes cannot be determined, but this affects PET scan billing for cancer patients under Medicare.
High impact
Percutaneous Image-Guided Lumbar Decompression for Lumbar Spinal Stenosis
Medicare/CMS - NCD·Effective Apr 30, 2026
Medicare has issued National Coverage Determination 150.13 for Percutaneous Image-Guided Lumbar Decompression procedures for Lumbar Spinal Stenosis. This establishes specific coverage criteria for this minimally invasive spinal procedure under Medicare.
Medium impact
Noninvasive Positive Pressure Ventilation (NIPPV) in the Home for the Treatment of Chronic Respiratory Failure (CRF) Consequent to Chronic Obstructive Pulmonary Disease (COPD)
Medicare/CMS - NCD·Effective May 29, 2026
This is a National Coverage Determination establishing Medicare coverage criteria for noninvasive positive pressure ventilation (NIPPV) devices used at home for treating chronic respiratory failure caused by COPD. The policy defines specific medical criteria and documentation requirements that must be met for Medicare to cover these breathing support devices.
Medium impact
Next Generation Sequencing (NGS)
Medicare/CMS - NCD·Effective Apr 30, 2026
This is a National Coverage Determination for Next Generation Sequencing (NGS) from CMS, affecting Medicare coverage policies for genetic testing services. The policy appears to be an update to existing NGS coverage guidelines that will impact billing and coverage requirements for genetic testing procedures.
Medium impact
Lung Cancer Screening with Low Dose Computed Tomography (LDCT)
Medicare/CMS - NCD·Identified Jun 17, 2026
This is a National Coverage Determination for lung cancer screening with Low Dose Computed Tomography (LDCT) from Medicare. However, the policy content provided only contains header information without the actual coverage criteria, billing codes, or specific requirements.
Medium impact
Home Prothrombin Time/International Normalized Ratio (PT/INR) Monitoring for Anticoagulation Management
Medicare/CMS - NCD·Effective Apr 14, 2026
This is a National Coverage Determination for home PT/INR monitoring devices used by patients on anticoagulation therapy. The policy establishes Medicare coverage criteria for home testing equipment and supplies for patients managing blood clotting medications.
Medium impact
Cardiac Contractility Modulation (CCM) for Heart Failure (HF)
Medicare/CMS - NCD·Effective May 29, 2026
Medicare has established a new National Coverage Determination for Cardiac Contractility Modulation (CCM) devices for heart failure treatment. This policy provides specific coverage criteria and billing guidance for CCM procedures that were previously not covered under Medicare.
Medium impact
Aprepitant for Chemotherapy-Induced Emesis
Medicare/CMS - NCD·Effective Apr 30, 2026
This is a National Coverage Determination for Aprepitant, a medication used to prevent chemotherapy-induced nausea and vomiting. The policy establishes Medicare coverage criteria for this anti-emetic drug when used in conjunction with cancer treatment.
High impact
Anti-Cancer Chemotherapy for Colorectal Cancer - RETIRED
Medicare/CMS - NCD·Effective Apr 23, 2026
Medicare's National Coverage Determination 110.17 for Anti-Cancer Chemotherapy for Colorectal Cancer has been RETIRED as of April 23, 2026. This means the specific Medicare coverage guidelines for colorectal cancer chemotherapy under this NCD are no longer in effect, potentially affecting how these treatments are covered and billed.

Medicare/CMS - NCD: Cardiology Medicare/CMS - NCD: Cardiothoracic Surgery Medicare/CMS - NCD: Critical Care Medicare/CMS - NCD: Diagnostic Imaging All payers

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Xenon Scan - RETIRED

Vagus Nerve Stimulation (VNS)

Transcatheter Tricuspid Valve Replacement (TTVR)

Transcatheter Edge-to-Edge Repair for Tricuspid Valve Regurgitation (T-TEER)

Screening for Sexually Transmitted Infections (STIs) and High-Intensity Behavioral Counseling (HIBC) to Prevent STIs

Screening for Hepatitis C Virus (HCV) in Adults

Renal Denervation (RDN) for Uncontrolled Hypertension

Pre-Exposure Prophylaxis (PrEP) for Human Immunodeficiency Virus (HIV) Prevention

Positron Emission Tomography (FDG) for Oncologic Conditions

Percutaneous Image-Guided Lumbar Decompression for Lumbar Spinal Stenosis

Noninvasive Positive Pressure Ventilation (NIPPV) in the Home for the Treatment of Chronic Respiratory Failure (CRF) Consequent to Chronic Obstructive Pulmonary Disease (COPD)

Next Generation Sequencing (NGS)

Lung Cancer Screening with Low Dose Computed Tomography (LDCT)

Home Prothrombin Time/International Normalized Ratio (PT/INR) Monitoring for Anticoagulation Management

Cardiac Contractility Modulation (CCM) for Heart Failure (HF)

Aprepitant for Chemotherapy-Induced Emesis

Anti-Cancer Chemotherapy for Colorectal Cancer - RETIRED