Key facts for NCD 140.9
- Benefit category
- Physicians' Services
- Effective date
- 08/30/2016
- Implemented 04/04/2017
- Transmittal
- Transmittal 194
- Versions published
- 1
- Manual chapter
- 140
- NCD Manual (Pub. 100-03)
TL;DR
NCD 140.9 sets Medicare's national policy for gender dysphoria and gender reassignment surgery under the benefit category "Physicians' Services", effective 08/30/2016 and implemented 04/04/2017. The Centers for Medicare & Medicaid Coverage (CMS) conducted a National Coverage Analysis that focused on the topic of gender reassignment surgery. Effective August 30, 2016, after examining the medical evidence, CMS determined that no national coverage… It has been revised once since publication and binds every Medicare Administrative Contractor nationally.
Item or service described
A. General
Gender reassignment surgery is a general term to describe a surgery or surgeries that affirm a person's gender identity.
Indications and limitations of coverage
B. Nationally Covered Indications
N/A
C. Nationally Non-Covered Indications
N/A
D. Other
The Centers for Medicare & Medicaid Coverage (CMS) conducted a National Coverage Analysis that focused on the topic of gender reassignment surgery. Effective August 30, 2016, after examining the medical evidence, CMS determined that no national coverage determination (NCD) is appropriate at this time for gender reassignment surgery for Medicare beneficiaries with gender dysphoria. In the absence of an NCD, coverage determinations for gender reassignment surgery, under section 1862(a)(1)(A) of the Social Security Act (the Act) and any other relevant statutory requirements, will continue to be made by the local Medicare Administrative Contractors (MACs) on a case-by-case basis.
(This policy last reviewed August 2016.)
Text reproduced from the CMS Medicare Coverage Database record for NCD 140.9 version 1. View the original on cms.gov.
Revision history
03/2017 - Effective Date: 08/30/2016. Implementation Date: 04/04/2017. ( TN 194 ) (CR9981)
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 140.9
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 140.9
What does NCD 140.9 cover?
The Centers for Medicare & Medicaid Coverage (CMS) conducted a National Coverage Analysis that focused on the topic of gender reassignment surgery. Effective August 30, 2016, after examining the medical evidence, CMS determined that no national coverage determination (NCD) is appropriate at this time for gender reassignment surgery for Medicare beneficiaries with gender dysphoria. In the absence of an NCD, coverage… The full indications and limitations are reproduced on this page from the CMS Medicare Coverage Database.
When did NCD 140.9 take effect?
The current version (1) is effective 08/30/2016, implemented 04/04/2017, published in transmittal 194. This is the only published version.
Does a Local Coverage Determination override NCD 140.9?
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.