Key facts for NCD 110.2
- Benefit category
- Drugs and Biologicals, Inpatient Hospital Services, Oral Anticancer Drugs
- Effective date
- 10/01/1980
- Transmittal
- n/a
- Versions published
- 1
- Manual chapter
- 110
- NCD Manual (Pub. 100-03)
TL;DR
NCD 110.2 sets Medicare's national policy for certain drugs distributed by the national cancer institute under the benefit category "Drugs and Biologicals, Inpatient Hospital Services, Oral Anticancer Drugs", effective 10/01/1980. A physician is eligible to receive Group C drugs from the Divison of Cancer Treatment only if the following requirements are met: It has been revised once since publication and binds every Medicare Administrative Contractor nationally.
Item or service described
Under its Cancer Therapy Evaluation, the Division of Cancer Treatment of the National Cancer Institute (NCI), in cooperation with the Food and Drug Administration, approves and distributes certain drugs for use in treating terminally ill cancer patients. One group of these drugs, designated as Group C drugs, unlike other drugs distributed by the NCI, are not limited to use in clinical trials for the purpose of testing their efficacy. Drugs are classified as Group C drugs only if there is sufficient evidence demonstrating their efficacy within a tumor type and that they can be safely administered.
Indications and limitations of coverage
A physician is eligible to receive Group C drugs from the Divison of Cancer Treatment only if the following requirements are met:
• A physician must be registered with the NCI as an investigator by having completed an FD-Form 1573;
• A written request for the drug, indicating the disease to be treated, must be submitted to the NCI;
• The use of the drug must be limited to indications outlined in the NCI's guidelines; and
• All adverse reactions must be reported to the Investigational Drug Branch of the Division of Cancer Treatment.
In view of these NCI controls on distribution and use of Group C drugs, A/B Medicare Administrative Contractors (MACs) may assume, in the absence of evidence to the contrary, that a Group C drug and the related hospital stay are covered if all other applicable coverage requirements are satisfied.
If there is reason to question coverage in a particular case, the matter should be resolved with the assistance of the Quality Improvement Organization (QIO), or if there is none, the assistance of the MAC's medical consultants.
Information regarding those drugs which are classified as Group C drugs may be obtained from:
Chief, Investigational Drug Branch
Cancer Therapy Evaluation Program
Executive Plaza North, Suite 7134
National Cancer Institute
Rockville, Maryland 20852-7426
Text reproduced from the CMS Medicare Coverage Database record for NCD 110.2 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 110.2
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 110.2
What does NCD 110.2 cover?
A physician is eligible to receive Group C drugs from the Divison of Cancer Treatment only if the following requirements are met: The full indications and limitations are reproduced on this page from the CMS Medicare Coverage Database.
When did NCD 110.2 take effect?
The current version (1) is effective 10/01/1980. This is the only published version.
Does a Local Coverage Determination override NCD 110.2?
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.