Key facts for NCD 100.5
- Benefit category
- Diagnostic Tests (other)
- Effective date
- 06/12/1984
- Transmittal
- n/a
- Versions published
- 1
- Manual chapter
- 100
- NCD Manual (Pub. 100-03)
TL;DR
NCD 100.5 sets Medicare's national policy for diagnostic breath analyses under the benefit category "Diagnostic Tests (other)", effective 06/12/1984. • Lactulose breath hydrogen for diagnosing small bowel bacterial overgrowth and measuring small bowel transit time. It has been revised once since publication and binds every Medicare Administrative Contractor nationally.
Item or service described
Diagnostic breath analyses are tests performed to measure either the hydrogen or carbon dioxide content of the breath after the ingestion of certain compounds. The analyses are performed to diagnose certain gastrointestinal disease states.
Indications and limitations of coverage
The Following Breath Test is Covered:
• Lactose breath hydrogen to detect lactose malabsorption.
The Following Breath Tests are Excluded from Coverage:
• Lactulose breath hydrogen for diagnosing small bowel bacterial overgrowth and measuring small bowel transit time.
• CO2 for diagnosing bile acid malabsorption.
• CO2 for diagnosing fat malabsorption.
Text reproduced from the CMS Medicare Coverage Database record for NCD 100.5 version 1. View the original on cms.gov.
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 100.5
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 100.5
What does NCD 100.5 cover?
• Lactose breath hydrogen to detect lactose malabsorption. The full indications and limitations are reproduced on this page from the CMS Medicare Coverage Database.
When did NCD 100.5 take effect?
The current version (1) is effective 06/12/1984. This is the only published version.
Does a Local Coverage Determination override NCD 100.5?
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.