Key facts for NCD 20.25
- Benefit category
- Diagnostic Tests (other)
- Effective date
- 04/10/2023
- Implemented 04/10/2023
- Transmittal
- Transmittal 11892
- Versions published
- 3
- Manual chapter
- 20
- NCD Manual (Pub. 100-03)
TL;DR
NCD 20.25 sets Medicare's national policy for cardiac catheterization performed in other than a hospital setting - retired under the benefit category "Diagnostic Tests (other)", effective 04/10/2023 and implemented 04/10/2023. 20.25 - Cardiac Catheterization Performed in Other Than a Hospital Setting (RETIRED) It has been revised 2 times since publication and binds every Medicare Administrative Contractor nationally.
Indications and limitations of coverage
20.25 - Cardiac Catheterization Performed in Other Than a Hospital Setting (RETIRED)
(Rev. 11892; Issued: 03-09-23; Effective: 04-10-23; Implementation:04-10-23)
This section of the NCD Manual was repealed January 12, 2006.
Text reproduced from the CMS Medicare Coverage Database record for NCD 20.25 version 3. View the original on cms.gov.
Revision history
01/2006 - Repealed NCD. Effective date: 01/12/2006 Implementation Date: 02/27/2006 ( TN 46 ) (CR4280)
08/1986 - Replaced PSRO with PRO and emphasized that for procedure to be covered in a freestanding facility, carriers must request PRO review. Effective date NA. (TN 8)
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 20.25
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 20.25
What does NCD 20.25 cover?
20.25 - Cardiac Catheterization Performed in Other Than a Hospital Setting (RETIRED) The full indications and limitations are reproduced on this page from the CMS Medicare Coverage Database.
When did NCD 20.25 take effect?
The current version (3) is effective 04/10/2023, implemented 04/10/2023, published in transmittal 11892. CMS lists 3 versions of this NCD.
Does a Local Coverage Determination override NCD 20.25?
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.