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Acceptable National Coverage Determination (NCD) Complaints

NCD Name

NCD Number

Board Docket Number

Intervention Deadline

Resolution

Ocular Photodynamic Therapy

80.2.1

A-02-75

10/7/2004

Dismissed

Pancreas Transplants

35-82

A-04-89

1/1/2006

Dismissed*

Infusion Pumps

60-14

A-04-118

10/7/2004

Dismissed

Durable Medical Equipment Reference List — (Air Cleaners)

280.1

A-04-145

11/1/2005

Decision issued finding that record supports validity of the NCD. (DAB No. 1999)

Carcinoembryonic Antigen

190.26

A-07-106

11/30/2007

Dismissed**

Lipid Testing

190.23

A-09-3

 

Dismissed

Vagus Nerve Stimulation

160.18

A-09-67

8/24/2009

Dismissed

Magnetic Resonance Angiography

220.3

A-09-124

10/22/2009

Dismissed

Presbyopia-Correcting and Astigmatism-Correcting Intraocular Lenses

CMS Manual System, Pub. 100-04, Ch. 32, §120

A-10-97

12/21/2010

Decision issued finding that record supports validity of the NCD. (DAB No. 2418  - PDF)

Bariatric Surgery for Treatment of Morbid Obesity

100.1

A-11-92

8/22/2011

Dismissed

Adult Liver Transplantation

260.1

A-11-98

8/25/2011

Dismissed

Transsexual Surgery

140.3

A-13-47

 1/6/14

Decision issued finding that NCD is not valid under the "reasonableness standard" (DAB No. 2576)***

Vagus Nerve Stimulation

160.18

A-14-3

 8/1/2014

 

* The Board ruled that the record was not complete and adequate to support the validity of the NCD. The Centers for Medicare and Medicaid (CMS) agreed to reconsider the NCD. The NCD complaint was dismissed after CMS revised the NCD to address the concerns raised.

** The Board ruled that the beneficiary was not entitled to challenge the NCD for carcinoembryonic antigen (CEA) testing because CMS had determined that the NCD did not bar coverage for indications not specifically listed in the NCD as either covered or excluded from coverage. Rather, CMS determined that coverage of CEA testing for such indications required individual showings that testing was reasonable and necessary based on individual medical circumstances. A redacted copy of the Board’s dismissal ruling can be viewed through the following link: CEA NCD DISMISSAL RULING (PDF).

***The Board previously ruled that the NCD record is not complete and adequate to support the validity of the NCD. (NCD Ruling No. 2)

 

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Content created by Departmental Appeals Board
Content last reviewed on July 9, 2014