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Revised NCD list Effective from January'2020


This Change Request (CR) constitutes a maintenance update of ICD-10 conversions and other coding updates specific to NCDs effective from January 2020

These NCD coding changes are the results of newly available code sets and coding revisions to NCDs released separately.

The revised NCD lists are,

NCD110.18 Aprepitant:

  • Contractors shall add J9036 as covered effective July 1, 2019. 
  • Contractors shall delete S0178 as covered effective October 1, 2015.

NCD150.3 Bone Mineral Density Studies:

  • Contractors shall make a change to CR7818.5 requirement as follows: If HUBC is received with no modifier, post as both Professional Component (PC) and Technical Component (TC). 
  • Contractors shall add Current Procedural Terminology (CPT) 0554T, 0555T, 0556T, 0557T, 0558T as covered effective July 1, 2019 and apply same rules applied to CPT 77078. 
  • Contractors shall end-date ICD-10 dx M85.9, M89.9, M94.9, Q55.4 effective December 31, 2019.
  • CWF: Remove M89.9, M94.9 from error code 5805 effective January 1, 2020.

NCD220.4 Mammography:

  • Contractors shall add ICD-10 dx N63.15, N63.25 to covered dx effective October 1, 2019. 
  • Contractors shall end-date ICD-10 dx C44.501, C44.509, C50.911, C50.912, C50.921, C50.922, D05.91, D05.92, D49.2, D49.3, M70.90, M70.98, M70.99, M79.9, N60.91, N60.92, N63.10, N63.20, S21.001A, S21.002A, S29.001A, S29.009A, S29.9xxA, S39.001A, S39.91xA effective December 31, 2019.

NCD220.13 Percutaneous Image-Guided Breast Biopsy:

  • Contractors shall add ICD-10 dx N63.15, N63.25 to covered dx effective October 1, 2019. 
  • Contractors shall end-date ICD-10 dx C50.911, C50.912, C50.921, C50.922, D05.91, D05.92, N63.10, N63.20 effective December 31, 2019.

NCD270.3 Blood Derived-Products for Chronic, Non-Healing Wounds:

  • Contractors shall add ICD-10 dx as covered effective October 1, 2019: L89.016, L89.026, L89.116, L89.126, L89.136, L89.146, L89.156, L89.216, L89.226, L89.316, L89.326, L89.46, L89.516, L89.526, L89.616, L89.626, L89.816, L89.896

NCD20.7 Percutaneous Transluminal Angioplasty:

  • Contractors shall end-date ICD-10 procedure codes effective September 30, 2019: 037G346, 037G356, 037G366, 037G376, 037G3D6, 037G3E6, 037G3F6, 037G3G6, 037G446, 037G456, 037G466, 037G476, 037G4D6, 037G4E6, 037G4F6, 037G4G6, 037H346, 037H356, 037H366, 037H376, 037H3D6, 037H3E6, 037H3F6, 037H3G6, 037H446, 037H456, 037H466, 037H476, 037H4D6, 037H4E6, 037H4F6, 037H4G6, 037J346, 037J356, 037J366, 037J376, 037J3D6, 037J3E6, 037J3F6, 037J3G6, 037J446, 037J456, 037J466, 037J476, 037J4D6, 037J4E6, 037J4F6, 037J4G6, 037K346, 037K356, 037K366, 037K376, 037K3D6, 037K3E6, 037K3F6, 037K3G6, 037K446, 037K456, 037K466, 037K476, 037K4D6, 037K4E6, 037K4F6, 037K4G6, 037L346, 037L356, 037L366, 037L376, 037L3D6, 037L3E6, 037L3F6, 037L3G6, 037L446, 037L456, 037L466, 037L476, 037L4D6, 037L4E6, 037L4F6, 037L4G6, 037M346, 037M356, 037M366, 037M376, 037M3D6, 037M3E6, 037M3F6, 037M3G6, 037M446, 037M456, 037M466, 037M476, 037M4D6, 037M4E6, 037M4F6, 037M4G6, 037N346, 037N356, 037N366, 037N376, 037N3D6, 037N3E6, 037N3F6, 037N3G6, 037N446, 037N456, 037N466, 037N476, 037N4D6, 037N4E6, 037N4F6, 037N4G6.

NCD110.23 Stem Cell Transplantation:

  • Contractors shall end-date ICD-10 procedure codes 30250G0, 30250Y0, 30253G0, 30253Y0, 30260G0, 30260Y0, 30263G0, 30263Y0, 30250G1, 30250Y1, 30253G1, 30253Y1, 30260G1, 30260Y1, 30263G1, 30263Y1 effective September 30, 2019.
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Reference: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM11392.pdf

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