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NCD 20.27 · version 1

NCD 20.27: Cardiointegram (CIG) as an Alternative to Stress Test or Thallium Stress Test

Reviewed by QuickIntell RCM Editorial Team · Last reviewed

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

Key facts for NCD 20.27

Benefit category
Diagnostic Tests (other)
Effective date
This is a longstanding national coverage determination. The effective date of this version has not been posted.
Transmittal
n/a
Versions published
1
Manual chapter
20
NCD Manual (Pub. 100-03)

TL;DR

NCD 20.27 sets Medicare's national policy for cardiointegram (cig) as an alternative to stress test or thallium stress test under the benefit category "Diagnostic Tests (other)", effective This is a longstanding national coverage determination. The effective date of this version has not been posted.. Because this device is still considered investigational pending additional data on its clinical efficacy/sensitivity and value as a diagnostic tool, program payment may not be made for its use at this time. It has been revised once since publication and binds every Medicare Administrative Contractor nationally.

Item or service described

A cardiointegram device consists of a microcomputer which receives output from a standard electrocardiogram (EKG) and transforms it to produce a graphic representation of heart electrophysiologic signals. This procedure is used primarily as a substitute for Exercise Tolerance Testing with Thallium Imaging in patients for whom a resting EKG may be inadequate to identify changes compatible with coronary artery disease.

Indications and limitations of coverage

Because this device is still considered investigational pending additional data on its clinical efficacy/sensitivity and value as a diagnostic tool, program payment may not be made for its use at this time.

Text reproduced from the CMS Medicare Coverage Database record for NCD 20.27 version 1. View the original on cms.gov.

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 20.27

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 20.27

What does NCD 20.27 cover?

Because this device is still considered investigational pending additional data on its clinical efficacy/sensitivity and value as a diagnostic tool, program payment may not be made for its use at this time. The full indications and limitations are reproduced on this page from the CMS Medicare Coverage Database.

When did NCD 20.27 take effect?

The current version (1) is effective This is a longstanding national coverage determination. The effective date of this version has not been posted.. This is the only published version.

Does a Local Coverage Determination override NCD 20.27?

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).

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.