Key facts for NCD 20.8
- Benefit category
- Inpatient Hospital Services, Physicians' Services, Prosthetic Devices
- Effective date
- 08/13/2013
- Implemented 07/07/2014
- Transmittal
- Transmittal 161
- Versions published
- 3
- Manual chapter
- 20
- NCD Manual (Pub. 100-03)
TL;DR
NCD 20.8 sets Medicare's national policy for cardiac pacemakers under the benefit category "Inpatient Hospital Services, Physicians' Services, Prosthetic Devices", effective 08/13/2013 and implemented 07/07/2014. Rev. 161, Issued: 02-06-14, Effective: 08-13-13, Implementation: 07-07-14) It has been revised 2 times since publication and binds every Medicare Administrative Contractor nationally.
Indications and limitations of coverage
Rev. 161, Issued: 02-06-14, Effective: 08-13-13, Implementation: 07-07-14)
Text reproduced from the CMS Medicare Coverage Database record for NCD 20.8 version 3. View the original on cms.gov.
Revision history
02/2014 - Rev. 161, Issued: 02-06-14, Effective: 08-13-13, Implementation: 07-07-14) ( TN 161 ) (CR8525)
06/2004 - Made technical revision to TN 12 by incorporating an exception for Investigational Device Exemption Clinical Trials. Discard TN 12 and replace with TN 16. Effective and implementation dates 04/30/2004. ( TN 16 ) (CR 3369)
05/2004 - Made minor revisions to text to transfer focus of NCD from actual pacemaker implantation procedure itself to reasonable and necessary medical indications that justify cardiac pacing. Therefore, only framework of NCD revised and not NCD itself. Effective and implementation dates 04/30/2004. ( TN 12 ) (CR 3290)
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 20.8
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 20.8
What does NCD 20.8 cover?
Rev. 161, Issued: 02-06-14, Effective: 08-13-13, Implementation: 07-07-14) The full indications and limitations are reproduced on this page from the CMS Medicare Coverage Database.
When did NCD 20.8 take effect?
The current version (3) is effective 08/13/2013, implemented 07/07/2014, published in transmittal 161. CMS lists 3 versions of this NCD.
Does a Local Coverage Determination override NCD 20.8?
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.