Key facts for NCD 110.12
- Benefit category
- Diagnostic Tests (other)
- Effective date
- 08/01/1978
- Transmittal
- n/a
- Versions published
- 1
- Manual chapter
- 110
- NCD Manual (Pub. 100-03)
TL;DR
NCD 110.12 sets Medicare's national policy for challenge ingestion food testing under the benefit category "Diagnostic Tests (other)", effective 08/01/1978. This procedure is covered when it is used on an outpatient basis if it is reasonable and necessary for the individual patient. It has been revised once since publication and binds every Medicare Administrative Contractor nationally.
Item or service described
Challenge ingestion food testing is a safe and effective technique in the diagnosis of food allergies.
Indications and limitations of coverage
This procedure is covered when it is used on an outpatient basis if it is reasonable and necessary for the individual patient.
Challenge ingestion food testing has not been proven to be effective in the diagnosis of rheumatoid arthritis, depression, or respiratory disorders. Accordingly, its use in the diagnosis of these conditions is not reasonable and necessary within the meaning of section 1862(a)(1) of the Act, and no program payment is made for this procedure when it is so used.
Text reproduced from the CMS Medicare Coverage Database record for NCD 110.12 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 110.12
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 110.12
What does NCD 110.12 cover?
This procedure is covered when it is used on an outpatient basis if it is reasonable and necessary for the individual patient. The full indications and limitations are reproduced on this page from the CMS Medicare Coverage Database.
When did NCD 110.12 take effect?
The current version (1) is effective 08/01/1978. This is the only published version.
Does a Local Coverage Determination override NCD 110.12?
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.