Key facts for NCD 110.3
- Benefit category
- Blood Clotting Factors for Hemophilia Patients
- Effective date
- Longstanding NCD
- Date of this version not posted by CMS
- Transmittal
- n/a
- Versions published
- 1
TL;DR
NCD 110.3 sets Medicare's national policy for anti-inhibitor coagulant complex (aicc) under the benefit category "Blood Clotting Factors for Hemophilia Patients", as a longstanding NCD (CMS has not posted the effective date of its current version). Anti-inhibitor coagulant complex, AICC, is a drug used to treat hemophilia in patients with factor VIII inhibitor antibodies. AICC has been shown to be safe and effective and has Medicare coverage when furnished to patients with hemophilia A and inhibitor… It has been revised once since publication and binds every Medicare Administrative Contractor nationally.
Indications and limitations of coverage
Anti-inhibitor coagulant complex, AICC, is a drug used to treat hemophilia in patients with factor VIII inhibitor antibodies. AICC has been shown to be safe and effective and has Medicare coverage when furnished to patients with hemophilia A and inhibitor antibodies to factor VIII who have major bleeding episodes and who fail to respond to other, less expensive therapies.
Text reproduced from the CMS Medicare Coverage Database record for NCD 110.3 version 1. View the original on cms.gov.
How MACs bill NCD 110.3
A National Coverage Determination states the policy; the Medicare Administrative Contractors publish the articles that turn it into claim edits. 1 current article in the Medicare Coverage Database names NCD 110.3, 1 of them with a covered ICD-10-CM list, from 1 contractor. The lists can differ by contractor even though the NCD is national, because each MAC codes the policy for its own claims system; check the article of the contractor that processes the claim.
| Contractor | Articles |
|---|---|
| Palmetto GBA | A56065 |
A56065: Billing and Coding: Guidance for Anti-Inhibitor Coagulant Complex (AICC) National Coverage Determination (NCD) 110.3
Billing and Coding, effective 2026-10-01 · Palmetto GBA (10112, 10212, 10312, 11202, 11302, 11402, 11502) · CMS record
14 covered ICD-10-CM codes in 7 groups; 33 procedure codes: J7170, J7175, J7179, J7180, J7181, J7182, J7183, J7185, J7186, J7187, J7188, J7189 and 21 more. Check a diagnosis for J7170.
First covered codes: D68.2 Hereditary deficiency of other clotting factors; D66 Hereditary factor VIII deficiency; D68.01 Von Willebrand disease, type 1; D68.020 Von Willebrand disease, type 2A; D68.021 Von Willebrand disease, type 2B; D68.022 Von Willebrand disease, type 2M; …
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.
For teams evaluating QuickIntell software
Evaluate a coverage-review workflow around NCD 110.3
Explore QuickAuth for requirement checks, documentation preparation and status tracking with staff oversight. Bring the policy-review steps your team repeats to a scoped evaluation, and confirm plan-specific requirements and supported actions. Use QuickRCM to evaluate the separate claim and denial workflow; a published NCD is not an authorization or payment guarantee.
Optional software evaluation, not payer support or help with an individual claim. For coverage or payment decisions, use the official sources on this page. Do not include patient information in a demo booking or inquiry.
Frequently asked questions — NCD 110.3
What does NCD 110.3 cover?
Anti-inhibitor coagulant complex, AICC, is a drug used to treat hemophilia in patients with factor VIII inhibitor antibodies. AICC has been shown to be safe and effective and has Medicare coverage when furnished to patients with hemophilia A and inhibitor antibodies to factor VIII who have major bleeding episodes and who fail to respond to other, less expensive therapies. The full indications and limitations are reproduced on this page from the CMS Medicare Coverage Database.
When did NCD 110.3 take effect?
NCD 110.3 is a longstanding NCD (CMS has not posted the effective date of its current version); the current version is 1. This is the only published version.
Does a Local Coverage Determination override NCD 110.3?
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 2026-10-10. Verify against the primary file before billing or contracting decisions. The reference methodology explains how each figure is computed from these files.
- 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…
- Medicare Coverage Database, current Billing and Coding Articles exportVersion MCD release 2026-10-08 · effective 2026-10-04 · file article.csvSHA-256 5e95c4a8ac3664be…
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.
Found a figure that does not match the CMS file? Report a data correction with the CMS file and the value you expected; the request reaches the editorial team through the contact form.