Key facts for NCD 190.22
- Benefit category
- Diagnostic Laboratory Tests
- Effective date
- 11/25/2002
- Implemented 01/01/2003
- Transmittal
- Transmittal 17
- Versions published
- 1
- Manual chapter
- 190
- NCD Manual (Pub. 100-03)
- Lab edit list
- 1,455 covered ICD-10
- 245 non-covered
TL;DR
NCD 190.22 sets Medicare's national policy for thyroid testing under the benefit category "Diagnostic Laboratory Tests", effective 11/25/2002 and implemented 01/01/2003. Thyroid function tests are used to define hyper function, euthyroidism, or hypofunction of thyroid disease. Thyroid testing may be reasonable and necessary to: As a laboratory NCD it carries a national ICD-10 edit list: 1,455 diagnosis codes support medical necessity and 245 are denied, applied automatically by every Medicare contractor to 4 procedure codes.
Item or service described
Thyroid function studies are used to delineate the presence or absence of hormonal abnormalities of the thyroid and pituitary glands. These abnormalities may be either primary or secondary and often but not always accompany clinically defined signs and symptoms indicative of thyroid dysfunction.
Laboratory evaluation of thyroid function has become more scientifically defined. Tests can be done with increased specificity, thereby reducing the number of tests needed to diagnose and follow treatment of most thyroid disease. Measurements of serum sensitive thyroid-stimulating hormone (TSH) levels, complemented by determination of thyroid hormone levels [free thyroxine (fT-4) or total thyroxine (T4) with Triiodothyronine (T3) uptake] are used for diagnosis and follow-up of patients with thyroid disorders.
Additional tests may be necessary to evaluate certain complex diagnostic problems or on hospitalized patients, where many circumstances can skew tests results. When a test for total thyroxine (total T4 or T4 radioimmunoassay) or T3 uptake is performed, calculation of the free thyroxine index (FTI) is useful to correct for abnormal results for either total T4 or T3 uptake due to protein binding effects.
Indications and limitations of coverage
Indications
Thyroid function tests are used to define hyper function, euthyroidism, or hypofunction of thyroid disease. Thyroid testing may be reasonable and necessary to:
• Distinguish between primary and secondary hypothyroidism;
• Confirm or rule out primary hypothyroidism;
• Monitor thyroid hormone levels (for example, patients with goiter, thyroid nodules, or thyroid cancer);
• Monitor drug therapy in patients with primary hypothyroidism;
• Confirm or rule out primary hyperthyroidism; and
• Monitor therapy in patients with hyperthyroidism.
Thyroid function testing may be medically necessary in patients with disease or neoplasm of the thyroid and other endocrine glands. Thyroid function testing may also be medically necessary in patients with metabolic disorders; malnutrition; hyperlipidemia; certain types of anemia; psychosis and non-psychotic personality disorders; unexplained depression; ophthalmologic disorders; various cardiac arrhythmias; disorders of menstruation; skin conditions; myalgias; and a wide array of signs and symptoms, including alterations in consciousness; malaise; hypothermia; symptoms of the nervous and musculoskeletal system; skin and integumentary system; nutrition and metabolism; cardiovascular; and gastrointestinal system.
It may be medically necessary to do follow-up thyroid testing in patients with a personal history of malignant neoplasm of the endocrine system and in patients on long-term thyroid drug therapy.
Limitations
Testing may be covered up to two times a year in clinically stable patients; more frequent testing may be reasonable and necessary for patients whose thyroid therapy has been altered or in whom symptoms or signs of hyperthyroidism or hypothyroidism are noted.
Note: Scroll down for links to the quarterly Covered Code Lists (including narrative).
Text reproduced from the CMS Medicare Coverage Database record for NCD 190.22 version 1. View the original on cms.gov.
Laboratory NCD code lists (January 2026)
Medicare contractors apply this NCD through a national edit: the procedure codes below are paid only when the claim carries a covered diagnosis. The January 2026 list holds 1,455 covered and 245 non-covered ICD-10-CM codes plus 18 codes with other resolution rules.
4 procedure codes are edited against this NCD's diagnosis list. CPT codes are shown as numbers only; descriptors are licensed by the AMA.
| Code | Code set |
|---|---|
| 84436 | CPT (descriptor licensed by AMA) |
| 84439 | CPT (descriptor licensed by AMA) |
| 84443 | CPT (descriptor licensed by AMA) |
| 84479 | CPT (descriptor licensed by AMA) |
The first 40 of 1,455 covered diagnosis codes, with FY2027 ICD-10-CM descriptions. A claim with any covered code on the line supports medical necessity under the national edit.
| ICD-10-CM | Description | Effective |
|---|---|---|
| A1881 | Tuberculosis of thyroid gland | 2015-10-01 |
| C561 | Malignant neoplasm of right ovary | 2015-10-01 |
| C562 | Malignant neoplasm of left ovary | 2015-10-01 |
| C563 | Malignant neoplasm of bilateral ovaries | 2021-10-01 |
| C569 | Malignant neoplasm of unspecified ovary | 2015-10-01 |
| C73 | Malignant neoplasm of thyroid gland | 2015-10-01 |
| C758 | Malignant neoplasm with pluriglandular involvement, unspecified | 2015-10-01 |
| C7963 | Secondary malignant neoplasm of bilateral ovaries | 2021-10-01 |
| C7989 | Secondary malignant neoplasm of other specified sites | 2015-10-01 |
| C799 | Secondary malignant neoplasm of unspecified site | 2015-10-01 |
| D093 | Carcinoma in situ of thyroid and other endocrine glands | 2015-10-01 |
| D098 | Carcinoma in situ of other specified sites | 2015-10-01 |
| D270 | Benign neoplasm of right ovary | 2015-10-01 |
| D271 | Benign neoplasm of left ovary | 2015-10-01 |
| D279 | Benign neoplasm of unspecified ovary | 2015-10-01 |
| D34 | Benign neoplasm of thyroid gland | 2015-10-01 |
| D352 | Benign neoplasm of pituitary gland | 2015-10-01 |
| D353 | Benign neoplasm of craniopharyngeal duct | 2015-10-01 |
| D440 | Neoplasm of uncertain behavior of thyroid gland | 2015-10-01 |
| D442 | Neoplasm of uncertain behavior of parathyroid gland | 2015-10-01 |
| D449 | Neoplasm of uncertain behavior of unspecified endocrine gland | 2015-10-01 |
| D497 | Neoplasm of unspecified behavior of endocrine glands and other parts of nervous system | 2015-10-01 |
| D510 | Vitamin B12 deficiency anemia due to intrinsic factor deficiency | 2015-10-01 |
| D539 | Nutritional anemia, unspecified | 2015-10-01 |
| D590 | Drug-induced autoimmune hemolytic anemia | 2015-10-01 |
| D591 | — | 2015-10-01 |
| D5910 | Autoimmune hemolytic anemia, unspecified | 2020-10-01 |
| D5911 | Warm autoimmune hemolytic anemia | 2020-10-01 |
| D5912 | Cold autoimmune hemolytic anemia | 2020-10-01 |
| D5913 | Mixed type autoimmune hemolytic anemia | 2020-10-01 |
| D5919 | Other autoimmune hemolytic anemia | 2020-10-01 |
| D6489 | Other specified anemias | 2016-10-01 |
| D649 | Anemia, unspecified | 2015-10-01 |
| D8982 | Autoimmune lymphoproliferative syndrome [ALPS] | 2015-10-01 |
| D89831 | Cytokine release syndrome, grade 1 | 2020-10-01 |
| D89832 | Cytokine release syndrome, grade 2 | 2020-10-01 |
| D89833 | Cytokine release syndrome, grade 3 | 2020-10-01 |
| D89834 | Cytokine release syndrome, grade 4 | 2020-10-01 |
| D89835 | Cytokine release syndrome, grade 5 | 2020-10-01 |
| D89839 | Cytokine release syndrome, grade unspecified | 2020-10-01 |
245 diagnosis codes deny automatically under this NCD; the first 20 are shown.
| ICD-10-CM | Description |
|---|---|
| R99 | Ill-defined and unknown cause of mortality |
| Z0000 | Encounter for general adult medical examination without abnormal findings |
| Z0001 | Encounter for general adult medical examination with abnormal findings |
| Z00110 | Health examination for newborn under 8 days old |
| Z00111 | Health examination for newborn 8 to 28 days old |
| Z00121 | Encounter for routine child health examination with abnormal findings |
| Z00129 | Encounter for routine child health examination without abnormal findings |
| Z005 | Encounter for examination of potential donor of organ and tissue |
| Z006 | Encounter for examination for normal comparison and control in clinical research program |
| Z0070 | Encounter for examination for period of delayed growth in childhood without abnormal findings |
| Z0071 | Encounter for examination for period of delayed growth in childhood with abnormal findings |
| Z008 | Encounter for other general examination |
| Z020 | Encounter for examination for admission to educational institution |
| Z021 | Encounter for pre-employment examination |
| Z022 | Encounter for examination for admission to residential institution |
| Z023 | Encounter for examination for recruitment to armed forces |
| Z024 | Encounter for examination for driving license |
| Z025 | Encounter for examination for participation in sport |
| Z026 | Encounter for examination for insurance purposes |
| Z0271 | Encounter for disability determination |
Revision history
07/2004 - Published NCD in the NCD Manual without change to narrative contained in PM AB-02-110. Coding guidance now published in Medicare Lab NCD Manual. Effective and Implementation dates NA. ( TN 17 ) (CR 2130)
07/2002 - Implemented NCD. Effective date 11/25/02. Implementation date 1/01/03. ( TN AB-02-110 ) (CR 2130)
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 190.22
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 190.22
What does NCD 190.22 cover?
Thyroid function tests are used to define hyper function, euthyroidism, or hypofunction of thyroid disease. Thyroid testing may be reasonable and necessary to: The full indications and limitations are reproduced on this page from the CMS Medicare Coverage Database.
When did NCD 190.22 take effect?
The current version (1) is effective 11/25/2002, implemented 01/01/2003, published in transmittal 17. This is the only published version.
Does a Local Coverage Determination override NCD 190.22?
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).
Which diagnosis codes are covered under NCD 190.22?
The January 2026 laboratory NCD edit list contains 1,455 ICD-10-CM codes that support thyroid testing (for example A1881 Tuberculosis of thyroid gland; C561 Malignant neoplasm of right ovary; C562 Malignant neoplasm of left ovary) and 245 codes that deny. The list applies to 84436, 84439, 84443, 84479.
How often does the lab NCD code list for 190.22 change?
CMS updates the laboratory NCD edit module quarterly, with the January release carrying the annual ICD-10-CM code changes. Codes added or deleted mid-year appear in the quarterly change spreadsheets on the Lab NCDs page.
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…
- Laboratory NCD ICD-10 code lists, January 2026Version January 2026 · effective 2026-01-01 · file 2026100-Initial-ICD10-NCD-Spreadsheet-20250721-508.xlsxSHA-256 57ff5cd37ba523d3…
- ICD-10-CM FY2027 code descriptionsVersion FY2027 · effective 2026-10-01 · file icd10cm_codes_2027.txtSHA-256 3c0583a38ee0e848…
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.