Key facts for NCD 220.12
- Benefit category
- Diagnostic Tests (other)
- Effective date
- 10/01/2002
- Implemented 10/01/2002
- Transmittal
- Transmittal 156
- Versions published
- 1
- Manual chapter
- 220
- NCD Manual (Pub. 100-03)
TL;DR
NCD 220.12 sets Medicare's national policy for single photon emission computed tomography (spect) under the benefit category "Diagnostic Tests (other)", effective 10/01/2002 and implemented 10/01/2002. Frequency limitations: Medicare Administrative Contractor discretion. It has been revised once since publication and binds every Medicare Administrative Contractor nationally.
Item or service described
The single photon emission computed tomograph (SPECT) acquires information on the concentration of radionuclides introduced into the patient's body. It is useful in the diagnosis of several clinical conditions including:
• stress fracture.
• spondylosis.
• infection (e.g., discitis).
• tumor (e.g., osteoid osteoma).
• analyze blood flow to an organ, as in the case of myocardial viability.
• differentiate ischemic heart disease from dilated cardiomyopathy.
Indications and limitations of coverage
Frequency limitations: Medicare Administrative Contractor discretion.
In the case of myocardial viability, FDG positron emission tomography (PET) may be used following a SPECT that was found to be inconclusive. However, SPECT may not be used following an inconclusive FDG PET performed to evaluate myocardial viability.
Text reproduced from the CMS Medicare Coverage Database record for NCD 220.12 version 1. View the original on cms.gov.
Revision history
05/2002 - Added NCD as part of determination regarding myocardial viability. Effective and implementation dates 07/01/2002. ( TN 156 ) (CR 2138)
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 220.12
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 220.12
What does NCD 220.12 cover?
Frequency limitations: Medicare Administrative Contractor discretion. The full indications and limitations are reproduced on this page from the CMS Medicare Coverage Database.
When did NCD 220.12 take effect?
The current version (1) is effective 10/01/2002, implemented 10/01/2002, published in transmittal 156. This is the only published version.
Does a Local Coverage Determination override NCD 220.12?
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.