Traditional MedicareCoverageHigh impact
Surgical or Other Invasive Procedure Performed on the Wrong Body Part
Medicare/CMS - NCD·National Coverage Determination
We identified it
Sep 26, 2026
Summary
CMS National Coverage Determination 140.7 addresses Medicare coverage policy for surgical or other invasive procedures performed on the wrong body part. This policy establishes coverage rules and billing requirements when wrong-site surgery occurs. Billing teams must understand non-coverage provisions and proper claim handling for these high-risk sentinel events.
Action Required
Immediately: Billing team must review NCD 140.7 in full at https://www.cms.gov/medicare-coverage-database/data/ncd?ncdid=328&ncdver=1 to understand Medicare's coverage determination for wrong-site procedures. Obtain complete policy details including specific billing code implications, coverage denials, and claim submission requirements. Update internal compliance procedures to reflect this policy. Communicate findings to providers and surgical staff. Flag any claims involving wrong-site procedures for special handling per Medicare guidelines. Document all wrong-site incident claims separately for audit purposes. No claims should be submitted for wrong-site surgical procedures without explicit guidance from compliance and legal review.