Wiki Are Retired NCDs Applicable?


Zionville, NC
Best answers
We have received a denial on a claim for medical necessity, but the only NCD for the test is retired. Are retired NCDs applicable to tests that have taken place after their retirement date? Please help!
Could you include the Dx and CPT codes used on the claim?
You can still have a medical necessity denial even if there is no NCD or LCD. For example: You wouldn't code a CPT 29881 meniscectomy if the Dx was 648.10, kind of silly I know - but you'd be surprised what is on claims sometimes.
I think what I've seen when they're retiring NCDs or LCDs is something to the effect that, while the specific pre-pay edits are being retired, all claims are subject to review for medical necessity, and many of the principles in retired policies are still applicable.