Key facts for NCD 110.20
- Benefit category
- Incident to a physician's professional Service, Inpatient Hospital Services
- Effective date
- 03/20/2007
- Implemented 05/07/2007
- Transmittal
- Transmittal 67
- Versions published
- 1
- Manual chapter
- 110
- NCD Manual (Pub. 100-03)
TL;DR
NCD 110.20 sets Medicare's national policy for blood brain barrier osmotic disruption for treatment of brain tumors under the benefit category "Incident to a physician's professional Service, Inpatient Hospital Services", effective 03/20/2007 and implemented 05/07/2007. Effective for services performed on and after March 20, 2007, the Centers for Medicare & Medicaid Services determines that the use of osmotic BBBD is not reasonable and necessary when it is used as part of a treatment regimen for brain tumors. It has been revised once since publication and binds every Medicare Administrative Contractor nationally.
Item or service described
A. General
The blood brain barrier (BBB) of the central nervous system is characterized by tight junctions between vascular endothelial cells, which prevent or impede various naturally occurring and synthetic substances (including anti-cancer drugs) from entering brain tissue. The BBB may be partly responsible for the poor efficacy of chemotherapy for malignant primary or metastatic brain tumors.
The BBBD is the disruption of the tight junctions between the endothelial cells that line the capillaries in the brain accomplished by osmotic disruption, bradykinin or irradiation. Theoretically, disruption of the BBB may, in the treatment of brain tumors, increase the concentration of chemotherapy drugs delivered to the tumor and may prolong the drug-tumor contact time.
Osmotic disruption of the BBB is the most common technique used. Chemotherapeutic agents are given in conjunction with barrier disruption. The BBBD process includes all items and services necessary to perform the procedure, including hospitalization, monitoring, and repeated imaging procedures.
Indications and limitations of coverage
B. Nationally Covered Indications
N/A
C. Nationally Non-Covered Indications
Effective for services performed on and after March 20, 2007, the Centers for Medicare & Medicaid Services determines that the use of osmotic BBBD is not reasonable and necessary when it is used as part of a treatment regimen for brain tumors.
D. Other
This NCD does not alter in any manner the coverage of anti-cancer chemotherapy.
(This NCD last reviewed March 2007.)
Text reproduced from the CMS Medicare Coverage Database record for NCD 110.20 version 1. View the original on cms.gov.
Revision history
04/2007 - Effective for claims with dates of service on and after March 20, 2007, CMS determines that the use of osmotic blood brain barrier disruption is not reasonable and necessary when it is used as part of a treatment regimen for brain tumors. This NCD does not alter in any manner the coverage of anti-cancer chemotherapy. Effective date: 03/20/2007. Implementation date: 05/07/2007 ( TN67 )
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 110.20
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 110.20
What does NCD 110.20 cover?
Effective for services performed on and after March 20, 2007, the Centers for Medicare & Medicaid Services determines that the use of osmotic BBBD is not reasonable and necessary when it is used as part of a treatment regimen for brain tumors. The full indications and limitations are reproduced on this page from the CMS Medicare Coverage Database.
When did NCD 110.20 take effect?
The current version (1) is effective 03/20/2007, implemented 05/07/2007, published in transmittal 67. This is the only published version.
Does a Local Coverage Determination override NCD 110.20?
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.