Key facts for NCD 220.5
- Benefit category
- Diagnostic Tests (other), Inpatient Hospital Services, Physicians' Services
- Effective date
- 05/22/2007
- Implemented 09/28/2007
- Transmittal
- Transmittal 76
- Versions published
- 3
- Manual chapter
- 220
- NCD Manual (Pub. 100-03)
TL;DR
NCD 220.5 sets Medicare's national policy for ultrasound diagnostic procedures under the benefit category "Diagnostic Tests (other), Inpatient Hospital Services, Physicians' Services", effective 05/22/2007 and implemented 09/28/2007. Category I - (Clinically effective, usually part of initial patient evaluation, may be an adjunct to radiologic and nuclear medicine diagnostic technique) It has been revised 2 times since publication and binds every Medicare Administrative Contractor nationally.
Item or service described
A. General
Ultrasound diagnostic procedures utilizing low energy sound waves are being widely employed to determine the composition and contours of nearly all body tissues except bone and air-filled spaces. This technique permits noninvasive visualization of even the deepest structures in the body. The use of the ultrasound technique is sufficiently developed that it can be considered essential to good patient care in diagnosing a wide variety of conditions.
Ultrasound diagnostic procedures are listed below and are divided into two categories. Medicare coverage is extended to the procedures listed in Category I. Periodic claims review by the A/Medicare Administrative Contractor (A/MAC) medical consultants should be conducted to ensure that the techniques are medically appropriate and the general indications specified in these categories are met. Techniques in Category II are considered experimental and should not be covered at this time.
Indications and limitations of coverage
B. Nationally Covered Indications
Category I - (Clinically effective, usually part of initial patient evaluation, may be an adjunct to radiologic and nuclear medicine diagnostic technique)
• Echoencephalography, (Diencephalic Midline) (A-Mode).
• Echoencephalography, Complete (Diencephalic Midline and Ventricular Size).
• Ocular and Orbital Echography (A-Mode).
• Covered procedures include efforts to determine the suitability of aphakic patients for implantation of an artificial lens (pseudophakoi) following cataract surgery.
• Ocular and Orbital Sonography (B-Mode).
• Echocardiography, Pericardial Effusion (M-Mode).
• Pericardiocentesis, by Ultrasonic Guidance.
• Echocardiography, Cardiac Valve(s) (M-Mode).
• Echocardiography, Complete (M-Mode).
• Echocardiography, limited (e.g., follow-up or limited study) (M-Mode).
• Pleural Effusion Echography.
• Thoracentesis, by Ultrasonic Guidance.
• Abdominal Sonography, complete survey study (B-Scan).
• Abdominal Sonography, limited (e.g., follow-up or limited study) (B-Scan).
• Abdominal Sonography is not synonymous with ultrasound examination of individual organs.
• Renal Cyst Aspiration, by Ultrasonic Guidance.
• Renal Biopsy, by Ultrasonic Guidance.
• Pancreas Sonography (B-Scan).
• Pancreatic Sonography has proven effective in diagnosing pseudocysts.
• Spleen Sonography (B-Scan).
• Abdominal Aorta Echography (A-Mode).
• Abdominal Aorta Sonography (B-Scan).
• Retroperitoneal Sonography (B-Scan).
• Retroperitoneal Sonography does not include planning of fields for radiation therapy.
• Urinary Bladder Sonography (B-Scan).
• Urinary bladder Sonography does not include staging of bladder tumors.
• Pregnancy Diagnosis Sonography (B-Scan).
• Fetal Age Determination (Biparietal Diameter) Sonography (B-Scan).
• Fetal Growth Rate Sonography (B-Scan).
• Placenta Localization Sonography (B-Scan).
• Pregnancy Sonography, Complete (B-Scan).
• Molar Pregnancy Diagnosis Sonography (B-Scan).
• Ectopic Pregnancy Diagnosis Sonography (B-Scan).
• Passive Testing (Antepartum Monitoring of Fetal Heart Rate In the Resting Fetus).
• Intrauterine Contraceptive Device Sonography (B-Scan).
• Pelvic Mass Diagnosis Sonography (B-Scan).
• Amniocentesis, by Ultrasonic Guidance.
• Arterial Flow Study, Peripheral (Doppler).
• Venous Flow Study, Peripheral (Doppler).
• Arterial Aneurysm, Peripheral (B-Scan).
• Radiation Therapy Planning Sonography (B-Scan).
• Thyroid Echography (A-Mode).
• Thyroid Sonography (B-Scan).
• Breast Echography (A-Mode).
• Breast Sonography (B-Scan).
• Hepatic Sonography (B-Scan).
• Gallbladder Sonography.
• Renal Sonography.
• Two-Dimensional Echocardiography (B-Mode).
• Monitoring of cardiac output (Esophageal Doppler) for ventilated patients in the ICU and operative patients with a need for intra-operative fluid optimization
C. Nationally Non-Covered Indications
Category II - (Clinical reliability and efficacy not proven):
• B-Scan for atherosclerotic narrowing of peripheral arteries.
D. Other
Uses for ultrasound diagnostic procedures not listed in Category I or II above are left to local MAC discretion. In view of the rapid changes in the field of ultrasound diagnosis, uses for ultrasound diagnostic procedures other than those listed under Categories I and II should be carefully reviewed before payment. Medical justification may be required.
(This NCD last reviewed June 2007.)
Text reproduced from the CMS Medicare Coverage Database record for NCD 220.5 version 3. View the original on cms.gov.
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 220.5
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 220.5
What does NCD 220.5 cover?
Category I - (Clinically effective, usually part of initial patient evaluation, may be an adjunct to radiologic and nuclear medicine diagnostic technique) The full indications and limitations are reproduced on this page from the CMS Medicare Coverage Database.
When did NCD 220.5 take effect?
The current version (3) is effective 05/22/2007, implemented 09/28/2007, published in transmittal 76. CMS lists 3 versions of this NCD.
Does a Local Coverage Determination override NCD 220.5?
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.