Key facts for NCD 140.6
- Benefit category
- Diagnostic Tests (other), Federally Qualified Health Center Services, Home Health Services, Inpatient Hospital Services, Outpatient Hospital Services Incident to a Physician's Service, Physicians' Services, Rural Health Clinic Services, Skilled Nursing Facility
- Effective date
- 01/15/2009
- Implemented 07/06/2009
- Transmittal
- Transmittal 102
- Versions published
- 1
- Manual chapter
- 140
- NCD Manual (Pub. 100-03)
TL;DR
NCD 140.6 sets Medicare's national policy for wrong surgical or other invasive procedure performed on a patient under the benefit category "Diagnostic Tests (other), Federally Qualified Health Center Services, Home Health Services, Inpatient Hospital Services, Outpatient Hospital Services Incident to a Physician's Service, Physicians' Services, Rural Health Clinic Services, Skilled Nursing Facility", effective 01/15/2009 and implemented 07/06/2009. The CMS does not cover a particular surgical or other invasive procedure to treat a particular medical condition when a practitioner erroneously performs a different procedure on a Medicare beneficiary because that particular surgical or other invasive… It has been revised once since publication and binds every Medicare Administrative Contractor nationally.
Item or service described
A. General
In 2002, the National Quality Forum (NQF) published “Serious Reportable Events in Healthcare: A Consensus Report" 1 , which listed 27 adverse events that were “serious, largely preventable and of concern to both the public and health care providers.” These events and subsequent revisions to the list became known as “never events.” This concept and need for the proposed reporting led to NQF’s “Consensus Standards Maintenance Committee on Serious Reportable Events,” which maintains and updates the list which currently contains 28 items. Among surgical events on the list is “Wrong surgical procedure performed on a patient.” Similar to any other patient population, Medicare beneficiaries experience serious injury and/or death if wrong surgeries are performed and may require additional healthcare in order to correct adverse outcomes resulting from such errors.
Indications and limitations of coverage
B. Nationally Covered Indications
N/A
C. Nationally Non-Covered Indications
The CMS does not cover a particular surgical or other invasive procedure to treat a particular medical condition when a practitioner erroneously performs a different procedure on a Medicare beneficiary because that particular surgical or other invasive procedure is not a reasonable and necessary treatment for the Medicare beneficiary’s particular medical condition.
A surgical or other invasive procedure is considered to be the wrong procedure if it is not consistent with the correctly documented informed consent for that patient. Emergent situations that occur in the course of surgery and/or whose exigency precludes obtaining informed consent are not considered erroneous under this decision. Also, the event is not intended to capture changes in the plan upon surgical entry into the patient due to the discovery of pathology in close proximity to the intended site when the risk of a second surgery outweighs the benefit of patient consultation; or the discovery of an unusual physical configuration (e.g., adhesions, spine level/extra vertebrae).
Surgical and other invasive procedures are defined as operative procedures in which skin or mucous membranes and connective tissue are incised or an instrument is introduced through a natural body orifice. Invasive procedures include a range of procedures from minimally invasive dermatological procedures (biopsy, excision, and deep cryotherapy for malignant lesions) to extensive multi-organ transplantation. They include all procedures described by the codes in the surgery section of the Current Procedural Terminology (CPT) and other invasive procedures such as percutaneous transluminal angioplasty and cardiac catheterization. They include minimally invasive procedures involving biopsies or placement of probes or catheters requiring the entry into a body cavity through a needle or trocar. They do not include use of instruments such as otoscopes for examinations or very minor procedures such as drawing blood.
D. Other
N/A
(NCD last reviewed January 2009.)
1 http://www.qualityforum.org/pdf/reports/sre.pdf
Text reproduced from the CMS Medicare Coverage Database record for NCD 140.6 version 1. View the original on cms.gov.
Revision history
07/2009 - Effective Date: 01/15/2009. Implementation Date: 07/06/2006 ( TN 102 ) (CR6405). Transmittal 101, Change Request 6405, dated June 12, 2009 is being rescinded and replaced, to correct manual references to the Benefit Policy Manual. All other information remains the same.
06/2009 - Effective Date: 01/15/2009. Implementation Date: 07/06/2006. ( TN 101 ) (CR6405)
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 140.6
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 140.6
What does NCD 140.6 cover?
The CMS does not cover a particular surgical or other invasive procedure to treat a particular medical condition when a practitioner erroneously performs a different procedure on a Medicare beneficiary because that particular surgical or other invasive procedure is not a reasonable and necessary treatment for the Medicare beneficiary’s particular medical condition. The full indications and limitations are reproduced on this page from the CMS Medicare Coverage Database.
When did NCD 140.6 take effect?
The current version (1) is effective 01/15/2009, implemented 07/06/2009, published in transmittal 102. This is the only published version.
Does a Local Coverage Determination override NCD 140.6?
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 2026-10-09. 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…
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.