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Medicare coverage reference

345 National Coverage Determinations with their indications, limitations and revision history, the 23 laboratory NCDs with national ICD-10 edit lists, and 7 Medicare Administrative Contractors with jurisdictions and 920 active Local Coverage Determinations, all rebuilt from the CMS Medicare Coverage Database.

Reviewed by QuickIntell RCM Editorial Team · Last reviewed

Data effective
Data currency: Medicare Coverage Database release of September 24, 2026 (effective September 20, 2026); Lab NCD code lists January 2026 (effective January 1, 2026). Next CMS release: weekly (Thursdays) for the MCD.

Laboratory NCDs with national ICD-10 edit lists

These are the only NCDs that come with machine-readable diagnosis lists. Each page shows the procedure codes edited, the covered and non-covered ICD-10 counts and samples, and the CMS policy text.

The 23 laboratory NCDs
NCDTestEffective
190.12Urine Culture, Bacterial11/25/2002
190.13Human Immunodeficiency Virus (HIV) Testing (Prognosis Including Monitoring)11/25/2002
190.14Human Immunodeficiency Virus (HIV) Testing (Diagnosis)12/08/2009
190.15Blood Counts11/25/2002
190.16Partial Thromboplastin Time (PTT)11/25/2002
190.17Prothrombin Time (PT)11/25/2002
190.18Serum Iron Studies11/25/2002
190.19Collagen Crosslinks, any Method11/25/2002
190.20Blood Glucose Testing01/01/2005
190.21Glycated Hemoglobin/Glycated Protein11/25/2002
190.22Thyroid Testing11/25/2002
190.23Lipid Testing01/01/2005
190.24Digoxin Therapeutic Drug Assay11/25/2002
190.25Alpha-fetoprotein11/25/2002
190.26Carcinoembryonic Antigen11/25/2002
190.27Human Chorionic Gonadotropin11/25/2002
190.28Tumor Antigen by Immunoassay - CA 12501/01/2006
190.29Tumor Antigen by Immunoassay - CA 15-3/CA 27.2911/25/2002
190.30Tumor Antigen by Immunoassay - CA 19-911/25/2002
190.31Prostate Specific Antigen11/25/2002
190.32Gamma Glutamyl Transferase11/25/2002
190.33Hepatitis Panel/Acute Hepatitis Panel11/25/2002
190.34Fecal Occult Blood Test11/25/2002

Medicare Administrative Contractors

CGS Administrators, LLC
204 LCDs · 37 states · AL AR CO DC DE FL GA IA IL IN …
First Coast Service Options, Inc.
79 LCDs · 3 states · FL PR VI
Noridian Healthcare Solutions, LLC
174 LCDs · 34 states · AK AS AZ CA CNMI CT DC DE GU HI …
Novitas Solutions, Inc.
71 LCDs · 12 states · AR CO DC DE LA MD MS NJ NM OK …
Palmetto GBA
190 LCDs · 18 states · AL AR FL GA IL IN KY LA MS NC …
Wellpoint Federal
89 LCDs · 28 states · AK AS AZ CA CNMI CT DN GU HI ID …
Wisconsin Physicians Service Insurance Corporation
113 LCDs · 48 states · AK AL AR AZ CA CO CT DE FL GA …

National Coverage Determinations by manual chapter

Chapter 20: Inpatient Hospital Services, Physicians' Services (40)

Chapter 110: Drugs and Biologicals (15)

Chapter 160: Physicians' Services (18)

Chapter 190: Diagnostic Laboratory Tests (30)

Chapter 210: Additional Preventive Services (15)

Chapter 300: Diagnostic Tests (other) (1)

Chapter 310: Ambulance Services, Ambulatory Surgical Center Facility Services, Antigens, Artificial Legs, Arms, and Eyes, Audiology Services, Blood Clotting Factors for Hemophilia Patients, Bone Mass Measurement, Certified Nurse-Midwife Services, Certified Registered Nurse Anesthetist Services, Chiropractor Services, Clinical Nurse Specialist Services, Clinical Social Worker Services, Colorectal Cancer Screening Tests, Comprehensive Outpatient Rehabilitation Facility (CORF) Services, Critical Access Hospital Services, Dentist Services, Diabetes Outpatient Self-Management Training, Diagnostic Laboratory Tests, Diagnostic Services in Outpatient Hospital, Diagnostic Tests (other), Diagnostic X-Ray Tests, Drugs and Biologicals, Durable Medical Equipment, Erythropoietin for Dialysis Patients, Extended Care Services, Eyeglasses After Cataract Surgery, Federally Qualified Health Center Services, Hepatitis B Vaccine and Administration, Home Dialysis Supplies and Equipment, Home Health Services, Hospice Care, Immunosuppressive Drugs, Incident to a physician's professional Service, Influenza Vaccine and Administration, Inpatient Hospital Services, Inpatient Psychiatric Hospital Services, Institutional Dialysis Services and Supplies, Leg, Arm, Back, and Neck Braces (orthotics), Medical Nutrition Therapy Services, Nurse Practitioner Services, Optometrist Services, Oral Anticancer Drugs, Oral Antiemetic Drugs, Orthotics and Prosthetics, Osteoporosis Drug, Outpatient Hospital Services Incident to a Physician's Service, Outpatient Occupational Therapy Services, Outpatient Physical Therapy Services, Outpatient Speech Language Pathology Services, Partial Hospitalization Services, Physician Assistant Services, Physicians' Services, Pneumococcal Vaccine and Administration, Podiatrist Services, Post-Hospital Extended Care Services, Post-Institutional Home Health Services, Prostate Cancer Screening Tests, Prosthetic Devices, Qualified Psychologist Services, Religious NonMedical Health Care Institution, Rural Health Clinic Services, Screening for Glaucoma, Screening Mammography, Screening Pap Smear, Screening Pelvic Exam, Self-Care Home Dialysis Support Services, Shoes for Patients with Diabetes, Skilled Nursing Facility, Splints, Casts, Other Devices Used for Reduction of Fractures and Dislocations, Surgical Dressings, Transplantation Services for ESRD-Entitled Beneficiaries, X-ray, Radium, and Radioactive Isotope Therapy (1)

How to use this reference

Start from the service, not the payer. If the service has a National Coverage Determination, that policy controls everywhere in the country and the NCD page gives the indications, limitations and effective dates to check before ordering or billing. If it is one of the 23 laboratory tests with a national edit list, the NCD page also shows which ICD-10-CM codes pay and which deny, which is the exact logic the contractor runs on the claim line. If no NCD applies, open the Medicare Administrative Contractor for the state where the service is furnished and search its active LCD list, because local policies differ by jurisdiction and a diagnosis covered by one contractor can deny under another. Pair the policy with the code pages: a drug's HCPCS page lists the coverage articles that mention it, and the denial pages explain the CARC and RARC combinations that a coverage denial produces.

Frequently asked questions

What is a National Coverage Determination?

An NCD is a nationwide decision by CMS on whether Medicare covers a specific item or service and under what conditions. It binds every Medicare Administrative Contractor and is published in the Medicare National Coverage Determinations Manual (Pub. 100-03).

What is a laboratory NCD code list?

For 23 clinical laboratory tests, CMS publishes national ICD-10-CM lists of covered and non-covered diagnoses. Contractors load them as automated edits, so a lab claim for one of those tests pays only when the line carries a covered diagnosis. The lists are updated quarterly.

How do I find which MAC covers my state?

Each Medicare Administrative Contractor hub on this page lists its contracts and the states in each jurisdiction. Institutional (Part A) and professional (Part B) claims use the A/B MAC; durable medical equipment claims go to the DME MAC for the region.

Where do LCDs fit?

Local Coverage Determinations are written by individual MACs for their jurisdictions where no NCD controls. The MAC hubs list every active LCD with its effective date and a link to the CMS record.

Sources

Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-02. Verify against the primary file before billing or contracting decisions.

Disclaimer

Operational reference compiled from the CMS Medicare Coverage Database. Coverage decisions depend on the full policy, the claim and the contractor. Not legal, clinical or billing advice.