Key facts for NCD 140.2
- Benefit category
- Physicians' Services
- Effective date
- 01/01/1997
- Transmittal
- Transmittal 96
- Versions published
- 1
- Manual chapter
- 140
- NCD Manual (Pub. 100-03)
TL;DR
NCD 140.2 sets Medicare's national policy for breast reconstruction following mastectomy under the benefit category "Physicians' Services", effective 01/01/1997. Reconstruction of the affected and the contralateral unaffected breast following a medically necessary mastectomy is considered a relatively safe and effective noncosmetic procedure. Accordingly, program payment may be made for breast reconstruction surgery… It has been revised once since publication and binds every Medicare Administrative Contractor nationally.
Item or service described
During recent years, there has been a considerable change in the treatment of diseases of the breast such as fibrocystic disease and cancer. While extirpation of the disease remains of primary importance, the quality of life following initial treatment is increasingly recognized as of great concern. The increased use of breast reconstruction procedures is due to several factors:
• A change in epidemiology of breast cancer, including an apparent increase in incidence;
• Improved surgical skills and techniques;
• The continuing development of better prostheses; and
• Increasing awareness by physicians of the importance of postsurgical psychological adjustment.
Indications and limitations of coverage
Reconstruction of the affected and the contralateral unaffected breast following a medically necessary mastectomy is considered a relatively safe and effective noncosmetic procedure. Accordingly, program payment may be made for breast reconstruction surgery following removal of a breast for any medical reason.
Program payment may not be made for breast reconstruction for cosmetic reasons. (Cosmetic surgery is excluded from coverage under §l862(a)(l0) of the Act.)
Text reproduced from the CMS Medicare Coverage Database record for NCD 140.2 version 1. View the original on cms.gov.
Revision history
04/1997 - Indicated that reconstruction of affected breast and contralateral unaffected breast following a medically necessary mastectomy are covered, and deleted references to ICD-9-CM codes. Effective date 01/01/1997. (TN 96)
08/1989 - Clarified coverage following a medically necessary mastectomy, and included applicable ICD-9-CM and HCPCS codes. Effective date NA. (TN 40)
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 140.2
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 140.2
What does NCD 140.2 cover?
Reconstruction of the affected and the contralateral unaffected breast following a medically necessary mastectomy is considered a relatively safe and effective noncosmetic procedure. Accordingly, program payment may be made for breast reconstruction surgery following removal of a breast for any medical reason. The full indications and limitations are reproduced on this page from the CMS Medicare Coverage Database.
When did NCD 140.2 take effect?
The current version (1) is effective 01/01/1997, published in transmittal 96. This is the only published version.
Does a Local Coverage Determination override NCD 140.2?
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.