Key facts for NCD 130.2
- Benefit category
- Outpatient Hospital Services Incident to a Physician's Service
- Effective date
- This is a longstanding national coverage determination. The effective date of this version has not been posted.
- Transmittal
- n/a
- Versions published
- 1
- Manual chapter
- 130
- NCD Manual (Pub. 100-03)
TL;DR
NCD 130.2 sets Medicare's national policy for outpatient hospital services for treatment of alcoholism under the benefit category "Outpatient Hospital Services Incident to a Physician's Service", effective This is a longstanding national coverage determination. The effective date of this version has not been posted.. Coverage is available for both diagnostic and therapeutic services furnished for the treatment of alcoholism by the hospital to outpatients subject to the same rules applicable to outpatient hospital services in general. While there is no coverage for day… It has been revised once since publication and binds every Medicare Administrative Contractor nationally.
Item or service described
Some hospitals also provide services on an outpatient basis, either individually or as part of a day hospitalization program, for treatment of alcoholism. These services may include, for example, drug therapy, psychotherapy, and patient education and may be furnished by physicians, psychologists, nurses, and alcoholism counselors to individuals who have been discharged from an inpatient hospital stay for treatment of alcoholism and require continued treatment or to individuals from the community who require treatment but do not require the inpatient hospital setting.
Indications and limitations of coverage
Coverage is available for both diagnostic and therapeutic services furnished for the treatment of alcoholism by the hospital to outpatients subject to the same rules applicable to outpatient hospital services in general. While there is no coverage for day hospitalization programs, per se, individual services which meet the requirements in the Medicare Benefit Policy Manual , Chapter 6, §20 may be covered. (Meals, transportation and recreational and social activities do not fall within the scope of covered outpatient hospital services under Medicare.)
All services must be reasonable and necessary for diagnosis or treatment of the patient's condition (see the Medicare Benefit Policy Manual , Chapter 16 §20). Thus, educational services and family counseling would only be covered where they are directly related to treatment of the patient's condition. The frequency of treatment and period of time over which it occurs must also be reasonable and necessary.
Text reproduced from the CMS Medicare Coverage Database record for NCD 130.2 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 130.2
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 130.2
What does NCD 130.2 cover?
Coverage is available for both diagnostic and therapeutic services furnished for the treatment of alcoholism by the hospital to outpatients subject to the same rules applicable to outpatient hospital services in general. While there is no coverage for day hospitalization programs, per se, individual services which meet the requirements in the Medicare Benefit Policy Manual , Chapter 6, §20 may be covered. (Meals,… The full indications and limitations are reproduced on this page from the CMS Medicare Coverage Database.
When did NCD 130.2 take effect?
The current version (1) is effective This is a longstanding national coverage determination. The effective date of this version has not been posted.. This is the only published version.
Does a Local Coverage Determination override NCD 130.2?
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.