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NCD 190.27 · version 1 · Laboratory NCD

NCD 190.27: Human Chorionic Gonadotropin

Reviewed by QuickIntell RCM Editorial Team · Last reviewed

Data effective
Data currency: Medicare Coverage Database release of September 24, 2026 (effective September 20, 2026); Lab NCD code lists January 2026 (effective January 1, 2026). Next CMS release: weekly (every Thursday) for the MCD; quarterly for lab NCD code lists.

Key facts for NCD 190.27

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
182 covered ICD-10
245 non-covered

TL;DR

NCD 190.27 sets Medicare's national policy for human chorionic gonadotropin under the benefit category "Diagnostic Laboratory Tests", effective 11/25/2002 and implemented 01/01/2003. Human Chorionic Gonadotropin (hCG) is useful for monitoring and diagnosis of germ cell neoplasms of the ovary, testis, mediastinum, retroperitoneum, and central nervous system. In addition, hCG is useful for monitoring pregnant patients with vaginal… As a laboratory NCD it carries a national ICD-10 edit list: 182 diagnosis codes support medical necessity and 245 are denied, applied automatically by every Medicare contractor to 1 procedure code.

Indications and limitations of coverage

Human Chorionic Gonadotropin (hCG) is useful for monitoring and diagnosis of germ cell neoplasms of the ovary, testis, mediastinum, retroperitoneum, and central nervous system. In addition, hCG is useful for monitoring pregnant patients with vaginal bleeding, hypertension and/or suspected fetal loss.

It is not reasonable and necessary to perform hCG testing more than once per month for diagnostic purposes. It may be performed as needed for monitoring of patient progress and treatment. Qualitative hCG assays are not appropriate for medically managing patients with known or suspected germ cell neoplasms.

Note: Scroll down for links to the quarterly Covered Code Lists (including narrative).

Text reproduced from the CMS Medicare Coverage Database record for NCD 190.27 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 182 covered and 245 non-covered ICD-10-CM codes plus 3 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.

Procedure codes subject to NCD 190.27
CodeCode set
84702CPT (descriptor licensed by AMA)

The first 40 of 182 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.

Covered ICD-10-CM codes for NCD 190.27 (sample)
ICD-10-CMDescriptionEffective
C381Malignant neoplasm of anterior mediastinum2015-10-01
C382Malignant neoplasm of posterior mediastinum2015-10-01
C383Malignant neoplasm of mediastinum, part unspecified2015-10-01
C388Malignant neoplasm of overlapping sites of heart, mediastinum and pleura2015-10-01
C451Mesothelioma of peritoneum2015-10-01
C480Malignant neoplasm of retroperitoneum2015-10-01
C481Malignant neoplasm of specified parts of peritoneum2015-10-01
C488Malignant neoplasm of overlapping sites of retroperitoneum and peritoneum2015-10-01
C561Malignant neoplasm of right ovary2015-10-01
C562Malignant neoplasm of left ovary2015-10-01
C563Malignant neoplasm of bilateral ovaries2021-10-01
C569Malignant neoplasm of unspecified ovary2015-10-01
C574Malignant neoplasm of uterine adnexa, unspecified2015-10-01
C58Malignant neoplasm of placenta2015-10-01
C6200Malignant neoplasm of unspecified undescended testis2015-10-01
C6201Malignant neoplasm of undescended right testis2015-10-01
C6202Malignant neoplasm of undescended left testis2015-10-01
C6210Malignant neoplasm of unspecified descended testis2015-10-01
C6211Malignant neoplasm of descended right testis2015-10-01
C6212Malignant neoplasm of descended left testis2015-10-01
C6290Malignant neoplasm of unspecified testis, unspecified whether descended or undescended2015-10-01
C6291Malignant neoplasm of right testis, unspecified whether descended or undescended2015-10-01
C6292Malignant neoplasm of left testis, unspecified whether descended or undescended2015-10-01
C753Malignant neoplasm of pineal gland2015-10-01
C781Secondary malignant neoplasm of mediastinum2015-10-01
C786Secondary malignant neoplasm of retroperitoneum and peritoneum2015-10-01
C7960Secondary malignant neoplasm of unspecified ovary2015-10-01
C7961Secondary malignant neoplasm of right ovary2015-10-01
C7962Secondary malignant neoplasm of left ovary2015-10-01
C7963Secondary malignant neoplasm of bilateral ovaries2021-10-01
C7982Secondary malignant neoplasm of genital organs2015-10-01
D392Neoplasm of uncertain behavior of placenta2015-10-01
D4959Neoplasm of unspecified behavior of other genitourinary organ2016-10-01
G893Neoplasm related pain (acute) (chronic)2015-10-01
J9859Other diseases of mediastinum, not elsewhere classified2016-10-01
N898Other specified noninflammatory disorders of vagina2015-10-01
N9489Other specified conditions associated with female genital organs and menstrual cycle2015-10-01
N99116Postprocedural urethral stricture, male, overlapping sites2018-10-01
O0000Abdominal pregnancy without intrauterine pregnancy2016-10-01
O0001Abdominal pregnancy with intrauterine pregnancy2016-10-01

245 diagnosis codes deny automatically under this NCD; the first 20 are shown.

Non-covered ICD-10-CM codes for NCD 190.27 (sample)
ICD-10-CMDescription
R99Ill-defined and unknown cause of mortality
Z0000Encounter for general adult medical examination without abnormal findings
Z0001Encounter for general adult medical examination with abnormal findings
Z00110Health examination for newborn under 8 days old
Z00111Health examination for newborn 8 to 28 days old
Z00121Encounter for routine child health examination with abnormal findings
Z00129Encounter for routine child health examination without abnormal findings
Z005Encounter for examination of potential donor of organ and tissue
Z006Encounter for examination for normal comparison and control in clinical research program
Z0070Encounter for examination for period of delayed growth in childhood without abnormal findings
Z0071Encounter for examination for period of delayed growth in childhood with abnormal findings
Z008Encounter for other general examination
Z020Encounter for examination for admission to educational institution
Z021Encounter for pre-employment examination
Z022Encounter for examination for admission to residential institution
Z023Encounter for examination for recruitment to armed forces
Z024Encounter for examination for driving license
Z025Encounter for examination for participation in sport
Z026Encounter for examination for insurance purposes
Z0271Encounter 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 190.27

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 190.27

What does NCD 190.27 cover?

Human Chorionic Gonadotropin (hCG) is useful for monitoring and diagnosis of germ cell neoplasms of the ovary, testis, mediastinum, retroperitoneum, and central nervous system. In addition, hCG is useful for monitoring pregnant patients with vaginal bleeding, hypertension and/or suspected fetal loss. The full indications and limitations are reproduced on this page from the CMS Medicare Coverage Database.

When did NCD 190.27 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 190.27?

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 190.27?

The January 2026 laboratory NCD edit list contains 182 ICD-10-CM codes that support human chorionic gonadotropin (for example C381 Malignant neoplasm of anterior mediastinum; C382 Malignant neoplasm of posterior mediastinum; C383 Malignant neoplasm of mediastinum, part unspecified) and 245 codes that deny. The list applies to 84702.

How often does the lab NCD code list for 190.27 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.

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.