Key facts for NCD 190.24
- 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
- 431 covered ICD-10
- 245 non-covered
TL;DR
NCD 190.24 sets Medicare's national policy for digoxin therapeutic drug assay under the benefit category "Diagnostic Laboratory Tests", effective 11/25/2002 and implemented 01/01/2003. Digoxin levels may be performed to monitor drug levels of individuals receiving digoxin therapy because the margin of safety between side effects and toxicity is narrow or because the blood level may not be high enough to achieve the desired clinical effect. As a laboratory NCD it carries a national ICD-10 edit list: 431 diagnosis codes support medical necessity and 245 are denied, applied automatically by every Medicare contractor to 1 procedure code.
Item or service described
A digoxin therapeutic drug assay is useful for diagnosis and prevention of digoxin toxicity, and/or prevention for under dosage of digoxin.
Indications and limitations of coverage
Indications
Digoxin levels may be performed to monitor drug levels of individuals receiving digoxin therapy because the margin of safety between side effects and toxicity is narrow or because the blood level may not be high enough to achieve the desired clinical effect.
Clinical indications may include individuals on digoxin:
• With symptoms, signs or electrocardiogram (ECG) suggestive of digoxin toxicity.
• Taking medications that influence absorption, bioavailability, distribution, and/or elimination of digoxin.
• With impaired renal, hepatic, gastrointestinal, or thyroid function.
• With pH and/or electrolyte abnormalities.
• With unstable cardiovascular status, including myocarditis.
• Requiring monitoring of patient compliance.
Clinical indications may include individuals:
• Suspected of accidental or intended overdose.
• Who have an acceptable cardiac diagnosis (as listed) and for whom an accurate history of use of digoxin is unobtainable.
The value of obtaining regular serum digoxin levels is uncertain, but it may be reasonable to check levels once yearly after a steady state is achieved. In addition, it may be reasonable to check the level if:
• Heart failure status worsens.
• Renal function deteriorates.
• Additional medications are added that could affect the digoxin level.
• Signs or symptoms of toxicity develop.
Steady state will be reached in approximately 1 week in patients with normal renal function, although 2-3 weeks may be needed in patients with renal impairment. After changes in dosages or the addition of a medication that could affect the digoxin level, it is reasonable to check the digoxin level one week after the change or addition. Based on the clinical situation, in cases of digoxin toxicity, testing may need to be done more than once a week.
Digoxin is indicated for the treatment of patients with heart failure due to systolic dysfunction and for reduction of the ventricular response in patients with atrial fibrillation or flutter. Digoxin may also be indicated for the treatment of other supraventricular arrhythmias, particularly in the presence of heart failure.
Limitations
This test is not appropriate for patients on digitoxin or treated with digoxin FAB (fragment antigen binding) antibody.
Note: Scroll down for links to the quarterly Covered Code Lists (including narrative).
Text reproduced from the CMS Medicare Coverage Database record for NCD 190.24 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 431 covered and 245 non-covered ICD-10-CM codes plus 1 codes with other resolution rules.
1 procedure code are edited against this NCD's diagnosis list. CPT codes are shown as numbers only; descriptors are licensed by the AMA.
| Code | Code set |
|---|---|
| 80162 | CPT (descriptor licensed by AMA) |
The first 40 of 431 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 |
|---|---|---|
| A1884 | Tuberculosis of heart | 2015-10-01 |
| E000 | Congenital iodine-deficiency syndrome, neurological type | 2015-10-01 |
| E001 | Congenital iodine-deficiency syndrome, myxedematous type | 2015-10-01 |
| E002 | Congenital iodine-deficiency syndrome, mixed type | 2015-10-01 |
| E009 | Congenital iodine-deficiency syndrome, unspecified | 2015-10-01 |
| E018 | Other iodine-deficiency related thyroid disorders and allied conditions | 2015-10-01 |
| E02 | Subclinical iodine-deficiency hypothyroidism | 2015-10-01 |
| E030 | Congenital hypothyroidism with diffuse goiter | 2015-10-01 |
| E031 | Congenital hypothyroidism without goiter | 2015-10-01 |
| E032 | Hypothyroidism due to medicaments and other exogenous substances | 2015-10-01 |
| E033 | Postinfectious hypothyroidism | 2015-10-01 |
| E035 | Myxedema coma | 2015-10-01 |
| E038 | Other specified hypothyroidism | 2015-10-01 |
| E039 | Hypothyroidism, unspecified | 2015-10-01 |
| E0500 | Thyrotoxicosis with diffuse goiter without thyrotoxic crisis or storm | 2015-10-01 |
| E0501 | Thyrotoxicosis with diffuse goiter with thyrotoxic crisis or storm | 2015-10-01 |
| E0510 | Thyrotoxicosis with toxic single thyroid nodule without thyrotoxic crisis or storm | 2015-10-01 |
| E0511 | Thyrotoxicosis with toxic single thyroid nodule with thyrotoxic crisis or storm | 2015-10-01 |
| E0520 | Thyrotoxicosis with toxic multinodular goiter without thyrotoxic crisis or storm | 2015-10-01 |
| E0521 | Thyrotoxicosis with toxic multinodular goiter with thyrotoxic crisis or storm | 2015-10-01 |
| E0530 | Thyrotoxicosis from ectopic thyroid tissue without thyrotoxic crisis or storm | 2015-10-01 |
| E0531 | Thyrotoxicosis from ectopic thyroid tissue with thyrotoxic crisis or storm | 2015-10-01 |
| E0540 | Thyrotoxicosis factitia without thyrotoxic crisis or storm | 2015-10-01 |
| E0541 | Thyrotoxicosis factitia with thyrotoxic crisis or storm | 2015-10-01 |
| E0580 | Other thyrotoxicosis without thyrotoxic crisis or storm | 2015-10-01 |
| E0581 | Other thyrotoxicosis with thyrotoxic crisis or storm | 2015-10-01 |
| E0590 | Thyrotoxicosis, unspecified without thyrotoxic crisis or storm | 2015-10-01 |
| E0591 | Thyrotoxicosis, unspecified with thyrotoxic crisis or storm | 2015-10-01 |
| E060 | Acute thyroiditis | 2015-10-01 |
| E061 | Subacute thyroiditis | 2015-10-01 |
| E062 | Chronic thyroiditis with transient thyrotoxicosis | 2015-10-01 |
| E063 | Autoimmune thyroiditis | 2015-10-01 |
| E064 | Drug-induced thyroiditis | 2015-10-01 |
| E065 | Other chronic thyroiditis | 2015-10-01 |
| E069 | Thyroiditis, unspecified | 2015-10-01 |
| E201 | Pseudohypoparathyroidism | 2015-10-01 |
| E8340 | Disorders of magnesium metabolism, unspecified | 2015-10-01 |
| E8341 | Hypermagnesemia | 2015-10-01 |
| E8342 | Hypomagnesemia | 2015-10-01 |
| E8349 | Other disorders of magnesium metabolism | 2015-10-01 |
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 190.24
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 190.24
What does NCD 190.24 cover?
Digoxin levels may be performed to monitor drug levels of individuals receiving digoxin therapy because the margin of safety between side effects and toxicity is narrow or because the blood level may not be high enough to achieve the desired clinical effect. The full indications and limitations are reproduced on this page from the CMS Medicare Coverage Database.
When did NCD 190.24 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 190.24?
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 190.24?
The January 2026 laboratory NCD edit list contains 431 ICD-10-CM codes that support digoxin therapeutic drug assay (for example A1884 Tuberculosis of heart; E000 Congenital iodine-deficiency syndrome, neurological type; E001 Congenital iodine-deficiency syndrome, myxedematous type) and 245 codes that deny. The list applies to 80162.
How often does the lab NCD code list for 190.24 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.