Key facts for NCD 10.6
- Benefit category
- Inpatient Hospital Services, Outpatient Hospital Services Incident to a Physician's Service, Physicians' Services
- Effective date
- 07/27/1988
- Transmittal
- Transmittal 29
- Versions published
- 2
- Manual chapter
- 10
- NCD Manual (Pub. 100-03)
TL;DR
NCD 10.6 sets Medicare's national policy for anesthesia in cardiac pacemaker surgery under the benefit category "Inpatient Hospital Services, Outpatient Hospital Services Incident to a Physician's Service, Physicians' Services", effective 07/27/1988. The use of general or monitored anesthesia during transvenous cardiac pacemaker surgery may be reasonable and necessary and therefore covered under Medicare only if adequate documentation of medical necessity is provided on a case-by-case basis. The Medicare… It has been revised 1 time since publication and binds every Medicare Administrative Contractor nationally.
Indications and limitations of coverage
The use of general or monitored anesthesia during transvenous cardiac pacemaker surgery may be reasonable and necessary and therefore covered under Medicare only if adequate documentation of medical necessity is provided on a case-by-case basis. The Medicare Administrative Contractor obtains advice from its medical consultants or from appropriate specialty physicians or groups in its locality regarding the adequacy of documentation before deciding whether a particular claim should be covered.
A second type of pacemaker surgery that is sometimes performed involves the use of the thoracic method of implantation, which requires open surgery. Where the thoracic method is employed, general anesthesia is always used and should not require special medical documentation.
Text reproduced from the CMS Medicare Coverage Database record for NCD 10.6 version 2. View the original on cms.gov.
Revision history
07/1988 - Covered use of general or monitored anesthesia during transvenous cardiac pacemaker surgery on a case-by-case basis when adequate documentation of medical necessity is provided. Effective date 07/27/1988. (TN 29)
01/1988 - Deleted existing noncoverage policy for acute myocardial infarction. Effective date 01/16/1988. (TN 21)
How this NCD shows up on remittances
A service denied under a National Coverage Determination returns CARC 50 (not deemed medically necessary) with remark N386 (decision based on an NCD); a denial citing a local policy instead carries N115. Because NCDs bind nationally, the appeal path is documentation that the patient meets the indications above, not a contractor-policy argument.
How QuickIntell applies NCD 10.6
QuickAuth checks the ordered service and diagnosis against NCD and LCD criteria before the encounter, QuickCode validates the diagnosis pairing on the claim, and QuickRCM routes CARC 50 denials with the policy text and the covered-code list attached so the appeal starts with evidence.
Frequently asked questions — NCD 10.6
What does NCD 10.6 cover?
The use of general or monitored anesthesia during transvenous cardiac pacemaker surgery may be reasonable and necessary and therefore covered under Medicare only if adequate documentation of medical necessity is provided on a case-by-case basis. The Medicare Administrative Contractor obtains advice from its medical consultants or from appropriate specialty physicians or groups in its locality regarding the adequacy… The full indications and limitations are reproduced on this page from the CMS Medicare Coverage Database.
When did NCD 10.6 take effect?
The current version (2) is effective 07/27/1988, published in transmittal 29. CMS lists 2 versions of this NCD.
Does a Local Coverage Determination override NCD 10.6?
No. A National Coverage Determination binds all Medicare Administrative Contractors; an LCD can only address services or circumstances the NCD leaves open. Claims denied under this NCD typically return CARC 50 with remark N386 (NCD) rather than N115 (LCD).
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.
- Medicare Coverage Database NCDs via the CMS Coverage APIVersion API snapshot 2026-09-27 · effective 2026-09-20 · file national-coverage-ncd.jsonSHA-256 a90fadfd264b9ef4…
Disclaimer
This page reproduces the CMS National Coverage Determination text and, for laboratory NCDs, the CMS ICD-10 edit lists, as an operational reference. Coverage decisions depend on the full policy, the claim and the contractor; nothing here is legal, clinical or billing advice. CPT codes are shown as numbers only; CPT descriptors are copyright AMA.