Key facts for NCD 190.9
- Benefit category
- Diagnostic Laboratory Tests
- Effective date
- 08/12/1987
- Transmittal
- Transmittal 33
- Versions published
- 1
- Manual chapter
- 190
- NCD Manual (Pub. 100-03)
TL;DR
NCD 190.9 sets Medicare's national policy for serologic testing for acquired immunodeficiency syndrome (aids) under the benefit category "Diagnostic Laboratory Tests", effective 08/12/1987. These tests may be covered when performed to help determine a diagnosis for symptomatic patients. They are not covered when furnished as part of a screening program for asymptomatic persons. It has been revised once since publication and binds every Medicare Administrative Contractor nationally.
Item or service described
Serologic testing is employed to detect antibodies to the AIDS virus, which is currently identified by the term "human immunodeficiency virus (HIV)." The virus originally was named "human T-cell lymphotropic virus, type III (HTLV-III), a term that remains in common usage.
Antibodies may be detected by a variety of immunoassay techniques, the most common being an enzyme linked immunosorbent assay (ELISA). When an assay is reactive on initial testing, it should be repeated on the same specimen. A more specific test, (Western blot, immunofluorescent assay) is usually performed following repeatedly reactive ELISA results.
Indications and limitations of coverage
These tests may be covered when performed to help determine a diagnosis for symptomatic patients. They are not covered when furnished as part of a screening program for asymptomatic persons.
NOTE : Two enzyme-linked immunosorbent assay (ELISA) tests that were conducted on the same specimen must both be positive before Medicare will cover the Western blot test.
Text reproduced from the CMS Medicare Coverage Database record for NCD 190.9 version 1. View the original on cms.gov.
Revision history
07/1987 - Provided coverage when needed to help determine a diagnosis for symptomatic patients and coverage when furnished as part of a screening program for asymptomatic people. Effective date 08/12/1987. (TN 17)
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 190.9
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 190.9
What does NCD 190.9 cover?
These tests may be covered when performed to help determine a diagnosis for symptomatic patients. They are not covered when furnished as part of a screening program for asymptomatic persons. The full indications and limitations are reproduced on this page from the CMS Medicare Coverage Database.
When did NCD 190.9 take effect?
The current version (1) is effective 08/12/1987, published in transmittal 33. This is the only published version.
Does a Local Coverage Determination override NCD 190.9?
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.