Key facts for NCD 200.1
- Benefit category
- Incident to a physician's professional Service, Inpatient Hospital Services
- Effective date
- 03/02/2006
- Implemented 05/22/2006
- Transmittal
- Transmittal 51
- Versions published
- 1
- Manual chapter
- 200
- NCD Manual (Pub. 100-03)
TL;DR
NCD 200.1 sets Medicare's national policy for nesiritide for treatment of heart failure patients under the benefit category "Incident to a physician's professional Service, Inpatient Hospital Services", effective 03/02/2006 and implemented 05/22/2006. Effective for dates of service on or after March 2, 2006, the Centers for Medicare & Medicaid Services has determined that there is sufficient evidence to conclude that the use of Nesiritide for the treatment of CHF is not reasonable and necessary for… It has been revised once since publication and binds every Medicare Administrative Contractor nationally.
Item or service described
A. General
Nesiritide (Natrecor®) is Food and Drug Administration (FDA)-approved for the intravenous treatment of patients with acutely decompensated congestive heart failure (CHF) who have dyspnea (shortness of breath) at rest or with minimal activity. Nesiritide is not self-administered.
Indications and limitations of coverage
B. Nationally Covered Indications
N/A
C. Nationally Non-Covered Indications
Effective for dates of service on or after March 2, 2006, the Centers for Medicare & Medicaid Services has determined that there is sufficient evidence to conclude that the use of Nesiritide for the treatment of CHF is not reasonable and necessary for Medicare beneficiaries in any setting.
D. Other
Effective for dates of service on or after March 2, 2006, this determination applies only to the treatment of CHF and does not change Medicare Administrative Contractor discretion to cover other off-label uses of Nesiritide or use consistent with the current FDA indication for intravenous treatment of patients with acutely decompensated CHF who have dyspnea at rest or with minimal activity.
Text reproduced from the CMS Medicare Coverage Database record for NCD 200.1 version 1. View the original on cms.gov.
Revision history
04/2006 - Issued NCD for Nesiritide for Treatment of Heart Failure Patients. Effective date: 03/02/2006. Implementation date: 05/22/2006. ( TN 51 ) (CR4312)
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 200.1
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 200.1
What does NCD 200.1 cover?
Effective for dates of service on or after March 2, 2006, the Centers for Medicare & Medicaid Services has determined that there is sufficient evidence to conclude that the use of Nesiritide for the treatment of CHF is not reasonable and necessary for Medicare beneficiaries in any setting. The full indications and limitations are reproduced on this page from the CMS Medicare Coverage Database.
When did NCD 200.1 take effect?
The current version (1) is effective 03/02/2006, implemented 05/22/2006, published in transmittal 51. This is the only published version.
Does a Local Coverage Determination override NCD 200.1?
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.