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Orthopedic Coding Alert

READER QUESTIONS:

Hold Local Medicare to NCDs

Published on Sat Aug 01, 2009

Question: Are National Coverage Determinations (NCD) binding on contractors? Michigan Subscriber Answer: Yes. According to a Medicare FAQ, NCDs are binding on the following: • all Medicare carriers • fiscal intermediaries • quality improvement organizations • health maintenance organizations • competitive medical plans • healthcare prepayment plans. Resource: You can find the link to the CMS FAQs at www.cms.hhs.gov. Just click on "Questions" near the top of the page. Remember: NCDs describe Medicare coverage of the described procedure or service on a national basis. Contractors can create their own coverage decisions for items not specifically covered or mentioned in NCDs. You can search NCDs at www.cms.hhs.gov/mcd/overview.asp or find them in the NCD manual at www.cms.hhs.gov/Manuals/ by clicking "Internet Only Manuals" and choosing publication 100-03.
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