Key facts for NCD 200.2
- Benefit category
- Durable Medical Equipment
- Effective date
- 09/10/2007
- Implemented 01/22/2008
- Transmittal
- Transmittal 79
- Versions published
- 1
- Manual chapter
- 200
- NCD Manual (Pub. 100-03)
TL;DR
NCD 200.2 sets Medicare's national policy for nebulized beta adrenergic agonist therapy for lung diseases under the benefit category "Durable Medical Equipment", effective 09/10/2007 and implemented 01/22/2008. After examining the available medical evidence, the Centers for Medicare & Medicaid Services determines that no national coverage determination is appropriate at this time. Section 1862(a)(1)(A) of the Social Security Act decisions should be made by local… It has been revised once since publication and binds every Medicare Administrative Contractor nationally.
Item or service described
A. General
Lung diseases such as chronic obstructive pulmonary disease (COPD) and asthma are characterized by airflow limitation that may be partially or completely reversible. Pharmacologic treatment with bronchodilators is used to prevent and/or control daily symptoms that may cause disability for persons with these diseases. These medications are intended to improve the movement of air into and from the lungs by relaxing and dilating the bronchial passageways. Beta adrenergic agonists are a commonly prescribed class of bronchodilator drug. They can be administered via nebulizer, metered dose inhaler, orally, or dry powdered inhaler.
Nebulized beta adrenergic agonist with racemic albuterol has been used for many years. More recently, levalbuterol, the (R) enantiomer of racemic albuterol, has been used in some patient populations. There are concerns regarding the appropriate use of nebulized beta adrenergic agonist therapy for lung disease.
Indications and limitations of coverage
B. Nationally Covered Indications
N/A
C. Nationally Non-Covered Indications
N/A
D. Other
After examining the available medical evidence, the Centers for Medicare & Medicaid Services determines that no national coverage determination is appropriate at this time. Section 1862(a)(1)(A) of the Social Security Act decisions should be made by local Medicare Administrative Contractors through a local coverage determination process or case-by-case adjudication. See Heckler v. Ringer, 466 U.S. 602, 617 (1984) (Recognizing that the Secretary has discretion to either establish a generally applicable rule or to allow individual adjudication.). See also, 68 Fed. Reg. 63692, 63693 (November 7, 2003).
Text reproduced from the CMS Medicare Coverage Database record for NCD 200.2 version 1. View the original on cms.gov.
Revision history
12/2007 - Provided noncoverage policy. Effective date 09/10/2007. ( TN 79 ) (CR5820)
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 200.2
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 200.2
What does NCD 200.2 cover?
After examining the available medical evidence, the Centers for Medicare & Medicaid Services determines that no national coverage determination is appropriate at this time. Section 1862(a)(1)(A) of the Social Security Act decisions should be made by local Medicare Administrative Contractors through a local coverage determination process or case-by-case adjudication. See Heckler v. Ringer, 466 U.S. 602, 617 (1984)… The full indications and limitations are reproduced on this page from the CMS Medicare Coverage Database.
When did NCD 200.2 take effect?
The current version (1) is effective 09/10/2007, implemented 01/22/2008, published in transmittal 79. This is the only published version.
Does a Local Coverage Determination override NCD 200.2?
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.