Key facts for NCD 20.10
- Benefit category
- Incident to a physician's professional Service
- Effective date
- 04/10/2023
- Implemented 04/10/2023
- Transmittal
- Transmittal 11892
- Versions published
- 4
- Manual chapter
- 20
- NCD Manual (Pub. 100-03)
TL;DR
NCD 20.10 sets Medicare's national policy for cardiac rehabilitation programs - retired under the benefit category "Incident to a physician's professional Service", effective 04/10/2023 and implemented 04/10/2023. (Rev. 11892; Issued: 03-09-23; Effective: 04-10-23; Implementation:04-10-23) It has been revised 3 times since publication and binds every Medicare Administrative Contractor nationally.
Item or service described
A. General
(Rev. 116; Issued: 03-05-10; Effective Date: 02-22-10; Implementation Date: 04-05-10)
This section of the NCD Manual was repealed February 22, 2010, as a result of section 144 of the Medicare Improvements for Patients and Providers Act. Instead, refer to Pub. 100-04, chapter 32, section 140.
Indications and limitations of coverage
20.10 - Cardiac Rehabilitation Programs (RETIRED)
(Rev. 11892; Issued: 03-09-23; Effective: 04-10-23; Implementation:04-10-23)
This section of the NCD Manual was repealed February 22, 2010, as a result of section 144 of the Medicare Improvements for Patients and Providers Act. Instead, refer to Pub.
100-04, chapter 32, section 140.
Text reproduced from the CMS Medicare Coverage Database record for NCD 20.10 version 4. View the original on cms.gov.
Revision history
03/2010 - This section of the NCD Manual was repealed February 22, 2010, as a result of section 144 of the Medicare Improvements for Patients and Providers Act. Instead, refer to Pub. 100-04, chapter 32, section 140. Effective date: 02/22/2010. Implementation date: 04/05/2010. ( TN 116 ) CR6855
04/2006 - The NCD Manual now includes a comprehensive description of the services that must be provided as part of a comprehensive cardiac rehabilitation program, extends the window of time during which the services must be provided and restructures the language for clarity. Effective date: 03/22/2006. Implementation date: 06/21/2006. ( TN 52 ) CR4149
08/1989 - Clarified term "direct supervision" to mean a physician must be immediately available and accessible but not required to be physicially present in excercise room itself. Effective date NA. (TN 41)
10/1985 - Clarified reimbursement limitation applied to freestanding clinics and coverage policy for physicial and occupational therapy. Effective date NA. (TN 2)
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 20.10
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 20.10
What does NCD 20.10 cover?
20.10 - Cardiac Rehabilitation Programs (RETIRED) The full indications and limitations are reproduced on this page from the CMS Medicare Coverage Database.
When did NCD 20.10 take effect?
The current version (4) is effective 04/10/2023, implemented 04/10/2023, published in transmittal 11892. CMS lists 4 versions of this NCD.
Does a Local Coverage Determination override NCD 20.10?
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.