Key facts for NCD 190.10
- Benefit category
- Diagnostic Laboratory Tests
- Effective date
- 10/01/1997
- Implemented 10/01/1997
- Transmittal
- Transmittal 101
- Versions published
- 1
- Manual chapter
- 190
- NCD Manual (Pub. 100-03)
TL;DR
NCD 190.10 sets Medicare's national policy for laboratory tests - crd patients under the benefit category "Diagnostic Laboratory Tests", effective 10/01/1997 and implemented 10/01/1997. Laboratory tests are essential to monitor the progress of CRD patients. The following list and frequencies of tests constitute the level and types of routine laboratory tests that are covered. Bills for other types of tests are considered nonroutine. Routine… It has been revised once since publication and binds every Medicare Administrative Contractor nationally.
Indications and limitations of coverage
Laboratory tests are essential to monitor the progress of CRD patients. The following list and frequencies of tests constitute the level and types of routine laboratory tests that are covered. Bills for other types of tests are considered nonroutine. Routine tests at greater frequencies must include medical justification. Nonroutine tests generally are justified by the diagnosis. The routinely covered regimen includes the following tests.
Per Dialysis
• All hematocrit or hemoglobin and clotting time tests furnished incident to dialysis treatments.
Per Week
• Prothrombin time for patients on anticoagulant therapy
• Serum Creatinine
Per Week or Thirteen Per Quarter
• BUN
Monthly
• CBC
• Serum Calcium
• Serum Potassium
• Serum Chloride
• Serum Bicarbonate
• Serum Phosphorous
• Total Protein
• Serum Albumin
• Alkaline Phospatase
• AST, SGOT
• LDH
Guidelines for tests other than those routinely performed include:
• Serum Aluminum - one every 3 months
• Serum Ferritin - one every 3 months
The following tests for hepatitis B are covered when patients first enter a dialysis facility: Hepatitis B surface antigen (HBsAg), Anti-HBs. Coverage of future testing in these patients depends on their serologic status and on whether they have been successfully immunized against hepatitis B virus. The following table summarizes the frequency of serologic surveillance for hepatitis B. Tests furnished according to this table do not require additional documentation and are paid separately because payment for maintenance dialysis treatments does not take them into account.
Frequency of Screening
Vaccination and Serologic Status
HBsAg Patients
Anti-HBs Patients
Unvaccinated
Susceptible
Monthly
Semiannually
Unvaccinated
HBsAg Carrier
Annually
None
Unvaccinated
Anti-HBs-Positive 1
None
Annually
Vaccinated
Anti-HBs-Positive 1
None
Annually
Vaccinted
Low Level or No Anti-HBs
Monthly
Semiannually
1 At least 10 sample ration units by radioimmunoassay or positive by enzyme immunoassay.
Patients who are in the process of receiving hepatitis B vaccines, but have not received the complete series, should continue to be routinely screened as susceptible. Between one and six months after the third dose, all vaccines should be tested for anti-HBs to confirm their response to the vaccine. Patients who have a level of anti-HBs of at least 10 sample ratio units (SRUs) by radioimmunoassay (RIA) or who are positive by enzyme immunoassay (EIA) are considered adequate responders to vaccine and need only be tested for anti-HBs annually to verify their immune status. If anti-HBs drops below 10 SRUs by RIA or is negative by EIA, a booster dose of hepatitis B vaccine should be given.
Laboratory tests are subject to the normal coverage requirements. If the laboratory services are performed by a free-standing facility, be sure it meets the conditions of coverage for independent laboratories.
Text reproduced from the CMS Medicare Coverage Database record for NCD 190.10 version 1. View the original on cms.gov.
Revision history
06/1997 - Clarified existing policy that Medicare will only pay separately for tests in excess of number included in computation of composit payment rate. Effective date 10/01/1997. (TN 101)
02/1997 - Eliminated certain tests from list of separately billable lab tests that are covered routinely without documentation of medial necessity. Effective date 07/01/1997. (TN 91)
10/1991 - Included hemoglobin as routinely covered test for CRD patient. Effective date 11/12/1991. (TN 53)
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 190.10
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 190.10
What does NCD 190.10 cover?
Laboratory tests are essential to monitor the progress of CRD patients. The following list and frequencies of tests constitute the level and types of routine laboratory tests that are covered. Bills for other types of tests are considered nonroutine. Routine tests at greater frequencies must include medical justification. Nonroutine tests generally are justified by the diagnosis. The routinely covered regimen… The full indications and limitations are reproduced on this page from the CMS Medicare Coverage Database.
When did NCD 190.10 take effect?
The current version (1) is effective 10/01/1997, implemented 10/01/1997, published in transmittal 101. This is the only published version.
Does a Local Coverage Determination override NCD 190.10?
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.