Key facts for NCD 230.3
- Benefit category
- Physicians' Services
- Effective date
- This is a longstanding national coverage determination. The effective date of this version has not been posted.
- Transmittal
- n/a
- Versions published
- 1
- Manual chapter
- 230
- NCD Manual (Pub. 100-03)
TL;DR
NCD 230.3 sets Medicare's national policy for sterilization under the benefit category "Physicians' Services", effective This is a longstanding national coverage determination. The effective date of this version has not been posted.. • Payment may be made only where sterilization is a necessary part of the treatment of an illness or injury, e.g., removal of a uterus because of a tumor, removal of diseased ovaries. It has been revised once since publication and binds every Medicare Administrative Contractor nationally.
Indications and limitations of coverage
A. Nationally Covered Conditions
• Payment may be made only where sterilization is a necessary part of the treatment of an illness or injury, e.g., removal of a uterus because of a tumor, removal of diseased ovaries.
• Sterilization of a mentally challenged beneficiary is covered if it is a necessary part of the treatment of an illness or injury (bilateral oophorectomy or bilateral orchidectomy in a case of cancer of the prostate). The Medicare Administrative Contractor denies claims when the pathological evidence of the necessity to perform any such procedures to treat an illness or injury is absent; and
• Monitor such surgeries closely and obtain the information needed to determine whether in fact the surgery was performed as a means of treating an illness or injury or only to achieve sterilization.
B. Nationally Non-Covered Conditions
• Elective hysterectomy, tubal ligation, and vasectomy, if the primary indication for these procedures is sterilization;
• A sterilization that is performed because a physician believes another pregnancy would endanger the overall general health of the woman is not considered to be reasonable and necessary for the diagnosis or treatment of illness or injury within the meaning of §1862(a)(1) of the Social Security Act. The same conclusion would apply where the sterilization is performed only as a measure to prevent the possible development of, or effect on, a mental condition should the individual become pregnant; and sterilization of a mentally retarded person where the purpose is to prevent conception, rather than the treatment of an illness or injury.
Text reproduced from the CMS Medicare Coverage Database record for NCD 230.3 version 1. 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 230.3
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 230.3
What does NCD 230.3 cover?
• Payment may be made only where sterilization is a necessary part of the treatment of an illness or injury, e.g., removal of a uterus because of a tumor, removal of diseased ovaries. The full indications and limitations are reproduced on this page from the CMS Medicare Coverage Database.
When did NCD 230.3 take effect?
The current version (1) is effective This is a longstanding national coverage determination. The effective date of this version has not been posted.. This is the only published version.
Does a Local Coverage Determination override NCD 230.3?
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.