Key facts for NCD 230.9
- Benefit category
- Inpatient Hospital Services, Outpatient Hospital Services Incident to a Physician's Service, Physicians' Services
- Effective date
- 07/01/2001
- Implemented 07/01/2001
- Transmittal
- Transmittal 140
- Versions published
- 1
- Manual chapter
- 230
- NCD Manual (Pub. 100-03)
TL;DR
NCD 230.9 sets Medicare's national policy for cryosurgery of prostate under the benefit category "Inpatient Hospital Services, Outpatient Hospital Services Incident to a Physician's Service, Physicians' Services", effective 07/01/2001 and implemented 07/01/2001. Cryosurgery of the prostate as a salvage therapy is not covered for any services performed prior to June 30, 2001. It has been revised once since publication and binds every Medicare Administrative Contractor nationally.
Item or service described
Cryosurgery of the prostate gland, also known as cryosurgical ablation of the prostate (CSAP), destroys prostate tissue by applying extremely cold temperatures in order to reduce the size of the prostate gland. It is safe and effective, as well as medically necessary and appropriate, as primary treatment for patients with clinically localized prostate cancer, Stages T1-T3.
Indications and limitations of coverage
Cryosurgery of the prostate as a salvage therapy is not covered for any services performed prior to June 30, 2001.
Salvage Cryosurgery of Prostate After Radiation Failure. Salvage cryosurgery of the prostate for recurrent cancer is medically necessary and appropriate only for those patients with localized disease who:
• Have failed a trial of radiation therapy as their primary treatment; and
• Meet one of the following conditions: Stage T2B or below, Gleason score
Cryosurgery as salvage therapy is therefore not covered under Medicare after failure of other therapies as the primary treatment. Cryosurgery as salvage is only covered after the failure of a trial of radiation therapy, under the conditions noted above.
Text reproduced from the CMS Medicare Coverage Database record for NCD 230.9 version 1. View the original on cms.gov.
Revision history
05/2021 - This Change Request (CR) constitutes a maintenance update of ICD-10 conversions and other coding updates specific to NCDs. These NCD coding changes are the result of newly available codes, coding revisions to NCDs released separately, or coding feedback received. ( TN 10804 ) (CR12124)
03/2021 - This Change Request (CR) constitutes a maintenance update of ICD-10 conversions and other coding updates specific to NCDs. These NCD coding changes are the result of newly available codes, coding revisions to NCDs released separately, or coding feedback received. ( TN 10624 ) (CR12124)
06/2016 - Transmittal 1665, dated May 13, 2016, is being rescinded and replaced by Transmittal 1672 to: (1) 9631.1: Remove FISS responsibility and 1st sentence; (2) 9631.2: Remove additional procedure codes, including 0075T, 0076T; (3) 9631.4: Revise descriptor of dx L59.8; (4) 9631.6: Add deletion of dx C49.10, C65.9, remove deletion of dx C54.9, remove deletion of invalid dx C47.90; (5) 9631.8: Remove deletion of invalid dx C51.29, replace with deletion of dx C50.029; (6) 9631.9: Add deletion of 0V504ZZ, 0V500ZZ, override capability, and contractor discretion verbiage. All other information remains the same. ( TN 1672 ) (CR9631)
05/2016 - This change request (CR) is the 7th maintenance update of ICD-10 conversions and other coding updates specific to national coverage determinations (NCDs). The majority of the NCDs included are a result of feedback received from previous ICD-10 NCD CR7818, CR8109, CR8197, CR8691, CR9087, CR9252, and CR9540. Some are the result of revisions required to other NCD-related CRs released separately.
Edits to ICD-10 and other coding updates specific to NCDs will be included in subsequent, quarterly releases as needed. No policy-related changes are included with these updates. Any policy-related changes to NCDs continue to be implemented via the current, long-standing NCD process. ( TN 1665 ) (CR9631)
09/2012 - CMS translated the information for this policy from ICD-9-CM/PCS to ICD-10-CM/PCS according to HIPAA standard medical data code set requirements and updated any necessary and related coding infrastructure. These updates do not expand, restrict, or alter existing coverage policy.Implementation date: 01/07/2013 Effective date: 10/1/2015. ( TN 1122 ) ( TN 1122 ) (CR 7818)
06/2001 - Expanded coverage for those patients who failed a trial of radiation treatment and met one of the limitations set forth in policy. Effective and implementation dates 07/01/2001. ( TN 140 ) (1632)
04/1999 - Allowed coverage only for primary treatment for patients with clinically localized prostate cancer, Stages T1-T3. Effective date 07/01/1999. (TN 110)
03/1997 - Provided noncoverage policy. Effective date 04/15/1997. (TN 93)
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 230.9
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 230.9
What does NCD 230.9 cover?
Cryosurgery of the prostate as a salvage therapy is not covered for any services performed prior to June 30, 2001. The full indications and limitations are reproduced on this page from the CMS Medicare Coverage Database.
When did NCD 230.9 take effect?
The current version (1) is effective 07/01/2001, implemented 07/01/2001, published in transmittal 140. This is the only published version.
Does a Local Coverage Determination override NCD 230.9?
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.