NCD (National Coverage Determination)
National Coverage Determination
A CMS-issued nationwide determination of whether Medicare will cover a particular service.
1 min read · Last reviewed May 23, 2026
At a glance
- Category
- Payer
- Acronym for
- National Coverage Determination
- Primary sources
- 1
- Workspace handoff
- ask d3 →
Where this comes up
Front-office and billing both hit this term — eligibility before the visit, prior auth before the procedure, contract terms during fee-schedule negotiation, and credentialing whenever a new provider joins or a payer roster lapses. Misses here become denials downstream.
Full definition
What it is in practice
NCDs override LCDs nationwide. They define the conditions for coverage of cardiac devices, oncology drugs, screening services, and other high-impact items.
How it shows up in your practice
When an NCD covers a service, every MAC must follow it. Stay current with NCD updates that affect your specialty.
Sources
- CMS — National Coverage Determinationshttps://www.cms.gov/medicare/coverage/determination-process
Check NCD details in Ask D3
Open ask d3 →Related terms
- PayerLCD (Local Coverage Determination)A MAC-published decision about whether a service is reasonable and necessary in its jurisdiction.
- CodingMedical NecessityThe standard requiring that services be reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.
- Denials & AppealsABN (Advance Beneficiary Notice of Non-coverage)A standardized notice (CMS-R-131) given to Medicare fee-for-service beneficiaries before furnishing a service Medicare may not cover.
D3rx is a healthcare-billing and compliance research aid maintained by D3rx Inc. Articles are drafted by an LLM (Anthropic Claude) against primary HHS, OCR, CMS, eCFR, NIST, and state-regulator publications, and reviewed for restraint and source fidelity by the D3rx team.
Reviewer status: a named credentialed reviewer (CHC, CHPC, or healthcare attorney) is being engaged. Until that engagement is finalized, this page does not claim credentialed review.
Related across the archive
- GlossaryMedical NecessityThe standard requiring that services be reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.
- GlossaryLCD (Local Coverage Determination)A MAC-published decision about whether a service is reasonable and necessary in its jurisdiction.
- GlossaryABN (Advance Beneficiary Notice of Non-coverage)A standardized notice (CMS-R-131) given to Medicare fee-for-service beneficiaries before furnishing a service Medicare may not cover.
- RegulationMLN: Medical Necessity — Local Coverage Determinations (LCDs) and National Coverage Determinations (NCDs)Reference to Medicare's coverage determinations: NCDs are issued by CMS; LCDs are issued by MACs; both define when an item or service is reasonable and necessary.
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- Glossary270/271 Eligibility Inquiry/ResponseThe HIPAA standard EDI transactions used to verify patient insurance eligibility (270 query, 271 response).
- GlossaryACA Marketplace PlanHealth plans sold through the federal or state-based health insurance marketplaces under the Affordable Care Act.
This glossary entry is a research aid for billing and compliance staff. It does not provide legal, medical, or financial advice and does not replace counsel. References cited link to primary sources at HHS, OCR, CMS, eCFR, NIST, and the relevant payer or industry body.