Key facts for NCD 230.13
- Benefit category
- Home Dialysis Supplies and Equipment
- Effective date
- 05/01/1989
- Transmittal
- Transmittal 36
- Versions published
- 1
- Manual chapter
- 230
- NCD Manual (Pub. 100-03)
TL;DR
NCD 230.13 sets Medicare's national policy for peridex capd filter set under the benefit category "Home Dialysis Supplies and Equipment", effective 05/01/1989. Based upon advice of our medical consultants, we have determined that the Peridex CAPD Filter Set cannot be covered at this time by Medicare because it has not yet been shown to be safe and effective in preventing peritonitis. It has been revised once since publication and binds every Medicare Administrative Contractor nationally.
Item or service described
The Peridex Filter Set is used by home continuous ambulatory peritoneal dialysis (CAPD) patients. The Peridex Filter Set is designed to provide sterile filtration during infusion of the dialysis solution in a beneficiary's peritoneal cavity; included in the filter set is a bacterial filter designed to block peritonitis-causing organisms and thus reduce the incidence of peritonitis.
Indications and limitations of coverage
Based upon advice of our medical consultants, we have determined that the Peridex CAPD Filter Set cannot be covered at this time by Medicare because it has not yet been shown to be safe and effective in preventing peritonitis.
Text reproduced from the CMS Medicare Coverage Database record for NCD 230.13 version 1. View the original on cms.gov.
Revision history
05/1989 - Re-categorized dialysis equipment from DME to Home Dialysis Supplies and Equipment for coverage purposes. Effective date NA. (TN 36)
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 230.13
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 230.13
What does NCD 230.13 cover?
Based upon advice of our medical consultants, we have determined that the Peridex CAPD Filter Set cannot be covered at this time by Medicare because it has not yet been shown to be safe and effective in preventing peritonitis. The full indications and limitations are reproduced on this page from the CMS Medicare Coverage Database.
When did NCD 230.13 take effect?
The current version (1) is effective 05/01/1989, published in transmittal 36. This is the only published version.
Does a Local Coverage Determination override NCD 230.13?
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.