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Member national coverage determinations

For Medicare members

Over the course of each benefit year, the Centers for Medicare & Medicaid Services (CMS) release National Coverage Determination (NCD) notices. These notices let Medicare beneficiaries know about new services or therapies that are covered or about a change in coverage under Original Medicare.

Throughout the plan year, we post all new or changed NCD notices from CMS. You can also view all NCD notices on the CMS website.

Please note that these NCD notices are coverage changes that have been made under Original Medicare, but these services may already be covered by your plan.

Have questions about these notices? Call our Customer Service department.


Date posted National Coverage Determination Notice
Nov. 16, 2023 Beta Amyloid Positron Tomography in Dementia and Neurodegenerative Disease (RETIRED)
Sep. 6, 2023 280.1 - Durable Medical Equipment Reference List
Sep. 6, 2023 280.16 - Seat Elevation Equipment (Power Operated) on Power Wheelchairs
Aug. 17, 2023 240.4 - Continuous Positive Airway Pressure (CPAP) Therapy For Obstructive Sleep Apnea (OSA)
Aug. 17, 2023 40.7 - Outpatient Intravenous Insulin Treatment
Aug. 17, 2023 140.7 - Surgical or Other Invasive Procedure Performed on the Wrong Body Part
Aug. 17, 2023 140.8 - Surgical or Other Invasive Procedure Performed on the Wrong Patient
Aug. 16, 2023 250.5 - Dermal Injections for the Treatment of Facial Lipodystrophy Syndrome (LDS)
Aug. 16, 2023 80.3 - Photosensitive Drugs
Aug. 15,2023 50.3 - Cochlear Implantation
Apr. 10, 2023 110.19 - Abarelix for the Treatment of Prostate Cancer - RETIRED
Apr. 10, 2023 160.22 - Ambulatory EEG Monitoring - RETIRED
Apr. 10, 2023 20.9 - Artificial Hearts and Related Devices - RETIRED
Apr. 10, 2023 20.25 - Cardiac Catheterization Performed in Other than a Hospital Setting - RETIRED
Apr. 10, 2023 20.10 - Cardiac Rehabilitation Programs - RETIRED
Apr. 10, 2023 160.6 - Carotid Sinus Nerve Stimulator - RETIRED
Apr. 10, 2023 230.11 - Diagnostic Pap Smears - RETIRED
Apr. 10, 2023 190.4 - Electron Microscope - RETIRED
Apr. 10, 2023 160.9 - Electronecephalographic (EEG) Monitoring During Open-Heart Surgery - RETIRED
Apr. 10, 2023 30.4 - Electrosleep Therapy - RETIRED
Apr. 10, 2023 180.2 - Enteral and Parenteral Nutritional Therapy - RETIRED
Apr. 10, 2023 20.5 - Extracorporeal Immunoadsorption (ECI) Using Protein A Columns (RETIRED)
Apr. 10, 2023 220.6.16 - FDG PET for Infection and Inflammation - RETIRED
Apr. 10, 2023 240.2.2 - Home Oxygen Use to Treat Cluster Headache (CH) - RETIRED
Apr. 10, 2023 100.9 - Implantation of Anti-Gastroesophageal Reflux Device - RETIRED
Apr. 10, 2023 100.8 - Intestinal Bypass Surgery - RETIRED
Apr. 10, 2023 220.3 - Magnetic Resonance Angiography - RETIRED
Apr. 10, 2023 220.2.1 - Magnetic Resonance Spectroscopy - RETIRED
Apr. 10, 2023 220.8 - Nuclear Radiology Procedure - RETIRED
Apr. 10, 2023 220.6 - Positron Emission Tomography (PET) Scans - RETIRED
Apr. 10, 2023 210.4 - Smoking and Tobacco-Use Cessation Counseling - RETIRED
Apr. 10, 2023 160.4 - Stereotactic Cingulotomy as a Means of Psychosurgery - RETIRED
Apr. 10, 2023 100.14 - Surgery for Diabetes - RETIRED
Apr. 10, 2023 50.6 - Tinnitus Masking - RETIRED
Apr. 10, 2023 280.13 - Transcutaneous Electrical Nerve Stimulators (TENS) - RETIRED
Apr. 10, 2023 240.6 - Transvenous (Catheter) Pulmonary Embolectomy (TPE) - RETIRED
Apr. 10, 2023 220.7 - Xenon Scan - RETIRED
Jan. 1, 2023 210.3 - Colorectal Cancer Screening Tests

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Medica Advantage Solution (HMO-POS), Medica Advantage Solution (PPO), and Medica Group Advantage Solution (PPO) Members
Toll free: 1-866-269-6804 (TTY: 711)

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Toll free: 1-866-810-5032 (TTY: 711)

Medica Advantage Solution with CHI Health (HMO) and Medica Advantage Solution H3632-001 (PPO) Members
Toll free: 1-866-398-7374 (TTY: 711)

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Access to representatives may be limited at times.


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Last Updated: November 2022