Key facts for NCD 230.16
- Benefit category
- Prosthetic Devices
- Effective date
- 10/07/1996
- Transmittal
- Transmittal 89
- Versions published
- 1
- Manual chapter
- 230
- NCD Manual (Pub. 100-03)
TL;DR
NCD 230.16 sets Medicare's national policy for bladder stimulators (pacemakers) under the benefit category "Prosthetic Devices", effective 10/07/1996. The use of spinal cord electrical stimulators, rectal electrical stimulators, and bladder wall stimulators is not considered reasonable and necessary. Therefore, no program payment may be made for these devices or for their implant. It has been revised once since publication and binds every Medicare Administrative Contractor nationally.
Item or service described
There are a number of devices available to induce emptying of the urinary bladder by using electrical current which forces the muscles of the bladder to contract. These devices (commonly known as bladder stimulators or pacemakers) are characterized by the implantation of electrodes in the wall of the bladder, the rectal cones, or the spinal cord. While these treatments may effectively empty the bladder, the issue of safety involving the initiation of infection, erosion, placement, and material selection has not been resolved. Further, some facilities previously using electronic emptying have stopped using this method due to the pain experienced by the patient.
Indications and limitations of coverage
The use of spinal cord electrical stimulators, rectal electrical stimulators, and bladder wall stimulators is not considered reasonable and necessary. Therefore, no program payment may be made for these devices or for their implant.
Text reproduced from the CMS Medicare Coverage Database record for NCD 230.16 version 1. View the original on cms.gov.
Revision history
09/1996 - Eliminated use of name brand products. Effective date 10/07/1996. (TN 89)
02/1995 - Reflected that pelvic floor stimulators used as a treatment for urinary incontinence are not covered. Effective date 03/01/1995. (TN 74)
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 230.16
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 230.16
What does NCD 230.16 cover?
The use of spinal cord electrical stimulators, rectal electrical stimulators, and bladder wall stimulators is not considered reasonable and necessary. Therefore, no program payment may be made for these devices or for their implant. The full indications and limitations are reproduced on this page from the CMS Medicare Coverage Database.
When did NCD 230.16 take effect?
The current version (1) is effective 10/07/1996, published in transmittal 89. This is the only published version.
Does a Local Coverage Determination override NCD 230.16?
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.