Key facts for NCD 190.7
- Benefit category
- Diagnostic Laboratory Tests
- Effective date
- 07/01/1996
- Transmittal
- Transmittal 88
- Versions published
- 1
- Manual chapter
- 190
- NCD Manual (Pub. 100-03)
TL;DR
NCD 190.7 sets Medicare's national policy for human tumor stem cell drug sensitivity assays under the benefit category "Diagnostic Laboratory Tests", effective 07/01/1996. Human tumor drug sensitivity assays are considered experimental, and therefore, not covered under Medicare at this time. It has been revised once since publication and binds every Medicare Administrative Contractor nationally.
Item or service described
Human tumor stem cell drug sensitivity assays involve exposure of human tumor stem cell colonies grown in tissue culture to anticancer drugs and observing for cytotoxic effects. Their purpose is to screen potential anticancer drugs and predict the effects of these drugs on tumors of individual patients, to allow the selection of the most effective drug or drugs for that patient.
The Fluorescent Cytoprint Assay, a miniaturized organ culture system for cancer chemosensitivity testing, allows for qualitative visual estimation of cell kill using low power microscopy and a noncytotoxic fluoresence probe for cell viability.
Indications and limitations of coverage
Human tumor drug sensitivity assays are considered experimental, and therefore, not covered under Medicare at this time.
The clinical application of the assay, based on testing in tumor microorgans rather than in clones derived from single cells, is considered experimental, and therefore, not covered under Medicare at this time.
Text reproduced from the CMS Medicare Coverage Database record for NCD 190.7 version 1. View the original on cms.gov.
Revision history
07/1996 - Clarified that the clinical application of fluorescent cytoprint assay is experimental and not covered. Effective date NA. (TN 88)
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 190.7
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 190.7
What does NCD 190.7 cover?
Human tumor drug sensitivity assays are considered experimental, and therefore, not covered under Medicare at this time. The full indications and limitations are reproduced on this page from the CMS Medicare Coverage Database.
When did NCD 190.7 take effect?
The current version (1) is effective 07/01/1996, published in transmittal 88. This is the only published version.
Does a Local Coverage Determination override NCD 190.7?
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.