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NCD 170.1 · version 1

NCD 170.1: Institutional and Home Care Patient Education Programs

Reviewed by QuickIntell RCM Editorial Team · Last reviewed

Data effective
Data currency: Medicare Coverage Database release of September 24, 2026 (effective September 20, 2026). Next CMS release: weekly (every Thursday) for the MCD; quarterly for lab NCD code lists.

Key facts for NCD 170.1

Benefit category
Extended Care Services, Home Health Services, Inpatient Hospital Services, Outpatient Hospital Services Incident to a Physician's Service, Outpatient Occupational Therapy Services, Outpatient Physical Therapy Services
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
170
NCD Manual (Pub. 100-03)

TL;DR

NCD 170.1 sets Medicare's national policy for institutional and home care patient education programs under the benefit category "Extended Care Services, Home Health Services, Inpatient Hospital Services, Outpatient Hospital Services Incident to a Physician's Service, Outpatient Occupational Therapy Services, Outpatient Physical Therapy Services", effective This is a longstanding national coverage determination. The effective date of this version has not been posted.. While the Act does not specifically identify patient education programs as covered services, reimbursement may be made under Medicare for such programs furnished by providers of services (i.e., hospitals, SNFs, HHAs, and OPT providers) to the extent that the… It has been revised once since publication and binds every Medicare Administrative Contractor nationally.

Indications and limitations of coverage

While the Act does not specifically identify patient education programs as covered services, reimbursement may be made under Medicare for such programs furnished by providers of services (i.e., hospitals, SNFs, HHAs, and OPT providers) to the extent that the programs are appropriate, integral parts in the rendition of covered services which are reasonable and necessary for the treatment of the individual's illness or injury. For example, educational activities carried out by nurses such as teaching patients to give themselves injections, follow prescribed diets, administer colostomy care, administer medical gases, and carry out other inpatient care activities may be reimbursable as a part of covered routine nursing care. Also, the teaching by an occupational therapist of compensatory techniques to improve a patient's level of independence in the activities of daily living may be reimbursed as a part of covered occupational therapy. Similarly, the instruction of a patient in the carrying out of a maintenance program designed for him/her by a physical therapist may be reimbursed as part of covered physical therapy.

However, when the educational activities are not closely related to the care and treatment of the patient, such as programs directed toward instructing patients or the public generally in preventive health care activities, reimbursement cannot be made since the Act limits Medicare payment to covered care which is reasonable and necessary for the treatment of an illness or injury. For example, programs designed to prevent illness by instructing the general public in the importance of good nutritional habits, exercise regimens, and good hygiene are not reimbursable under Medicare.

Text reproduced from the CMS Medicare Coverage Database record for NCD 170.1 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 170.1

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.

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Frequently asked questions — NCD 170.1

What does NCD 170.1 cover?

While the Act does not specifically identify patient education programs as covered services, reimbursement may be made under Medicare for such programs furnished by providers of services (i.e., hospitals, SNFs, HHAs, and OPT providers) to the extent that the programs are appropriate, integral parts in the rendition of covered services which are reasonable and necessary for the treatment of the individual's illness… The full indications and limitations are reproduced on this page from the CMS Medicare Coverage Database.

When did NCD 170.1 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 170.1?

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.

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.