Key facts for NCD 210.2.1
- Benefit category
- Additional Preventive Services
- Effective date
- 07/09/2015
- Implemented 03/07/2016
- Transmittal
- Transmittal 189
- Versions published
- 1
- Manual chapter
- 210
- NCD Manual (Pub. 100-03)
TL;DR
NCD 210.2.1 sets Medicare's national policy for screening for cervical cancer with human papillomavirus (hpv) under the benefit category "Additional Preventive Services", effective 07/09/2015 and implemented 03/07/2016. Effective for services performed on or after July 9, 2015, CMS has determined that the evidence is sufficient to add Human Papillomavirus (HPV) testing once every five years as an additional preventive service benefit under the Medicare program for… It has been revised once since publication and binds every Medicare Administrative Contractor nationally.
Item or service described
A. General
Medicare covers a screening pelvic examination and Pap test for all female beneficiaries at 12 or 24 month intervals, based on specific risk factors. See 42 C.F.R. § 410.56; Medicare National Coverage Determinations Manual, § 210.2.1 Current Medicare coverage does not include the HPV testing. Pursuant to §1861(ddd) of the Social Security Act, the Secretary may add coverage of "additional preventive services" if certain statutory requirements are met.
Indications and limitations of coverage
B. Nationally Covered Indications
Effective for services performed on or after July 9, 2015, CMS has determined that the evidence is sufficient to add Human Papillomavirus (HPV) testing once every five years as an additional preventive service benefit under the Medicare program for asymptomatic beneficiaries aged 30 to 65 years in conjunction with the Pap smear test. CMS will cover screening for cervical cancer with the appropriate U.S. Food and Drug Administration (FDA) approved/cleared laboratory tests, used consistent with FDA approved labeling and in compliance with the Clinical Laboratory Improvement Act (CLIA) regulations.
C. Nationally Non-Covered Indications
Unless specifically covered in this NCD, any other NCD, by statute or regulation, preventive services are non-covered by Medicare.
D. Other
N/A
(This NCD last reviewed July 2015.)
Text reproduced from the CMS Medicare Coverage Database record for NCD 210.2.1 version 1. View the original on cms.gov.
Revision history
02/2016 - The purpose of this this Change Request (CR) is that CMS has determined that for dates of service on or after effective July 9, 2015, evidence is sufficient to add HPV testing under specified conditions. Effective date: 07/09/2015 Implementation date: 03/07/2016 ( TN 189 ) (CR9434)
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 210.2.1
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 210.2.1
What does NCD 210.2.1 cover?
Effective for services performed on or after July 9, 2015, CMS has determined that the evidence is sufficient to add Human Papillomavirus (HPV) testing once every five years as an additional preventive service benefit under the Medicare program for asymptomatic beneficiaries aged 30 to 65 years in conjunction with the Pap smear test. CMS will cover screening for cervical cancer with the appropriate U.S. Food and… The full indications and limitations are reproduced on this page from the CMS Medicare Coverage Database.
When did NCD 210.2.1 take effect?
The current version (1) is effective 07/09/2015, implemented 03/07/2016, published in transmittal 189. This is the only published version.
Does a Local Coverage Determination override NCD 210.2.1?
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.