Key facts for NCD 240.8
- Benefit category
- No Benefit Category
- Effective date
- 09/25/2007
- Implemented 01/07/2008
- Transmittal
- Transmittal 78
- Versions published
- 1
- Manual chapter
- 240
- NCD Manual (Pub. 100-03)
TL;DR
NCD 240.8 sets Medicare's national policy for pulmonary rehabilitation services under the benefit category "No Benefit Category", effective 09/25/2007 and implemented 01/07/2008. The CMS has determined that a national coverage determination (NCD) for pulmonary rehabilitation is not appropriate at this time. Local Medicare Administrative Contractors should continue to make decisions under §1862(a)(1)(A) of the Act through their local… It has been revised once since publication and binds every Medicare Administrative Contractor nationally.
Item or service described
A. General
Pulmonary rehabilitation was defined in a 1999 joint statement of the American Thoracic Society and the European Respiratory Society as a multi-disciplinary program of care for patients with chronic respiratory impairment that is individually tailored and designed to optimize physical and social performance and autonomy and an evidence-based, multidisciplinary, and comprehensive intervention for patients with chronic respiratory diseases who are symptomatic and often have decreased daily life activities. Integrated into the individualized treatment of the patient, pulmonary rehabilitation is designed to reduce symptoms, optimize functional status, increase participation, and reduce health care costs through stabilizing or reversing systematic manifestations of the disease.
Although services that make up pulmonary rehabilitation individually may be covered under Medicare and fall into various applicable benefit categories, the Centers for Medicare & Medicaid Services (CMS) has determined that the Social Security Act (the Act) does not expressly define a comprehensive Pulmonary Rehabilitation Program as a Part B benefit. In addition, respiratory therapy services are identified as covered services under the Comprehensive Outpatient Rehabilitation Facility benefit and defined in 42 CFR 410.100(e)(1) to (2)(vi).
Indications and limitations of coverage
B. Nationally Covered Indications
N/A
C. Nationally Non-Covered Indications
N/A
D. Other
The CMS has determined that a national coverage determination (NCD) for pulmonary rehabilitation is not appropriate at this time. Local Medicare Administrative Contractors should continue to make decisions under §1862(a)(1)(A) of the Act through their local coverage determination (LCD) process or by case-by-case adjudication. See Heckler v. Ringer, 466 U.S. 602, 617 (1984) (Recognizing that the Secretary has discretion to either establish a generally applicable rule or to allow individual adjudication.). See also, 68 Fed. Reg. 63692, 63693 (November 7, 2003). LCDs can be accessed from the CMS search engine located at: http://www.cms.gov/mcd/search.asp .
(This NCD last reviewed September 2007.)
Text reproduced from the CMS Medicare Coverage Database record for NCD 240.8 version 1. View the original on cms.gov.
Revision history
12/2007 - Provided noncoverage policy. Effective date 09/25/2007. ( TN 78 ) (CR5834)
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 240.8
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 240.8
What does NCD 240.8 cover?
The CMS has determined that a national coverage determination (NCD) for pulmonary rehabilitation is not appropriate at this time. Local Medicare Administrative Contractors should continue to make decisions under §1862(a)(1)(A) of the Act through their local coverage determination (LCD) process or by case-by-case adjudication. See Heckler v. Ringer, 466 U.S. 602, 617 (1984) (Recognizing that the Secretary has… The full indications and limitations are reproduced on this page from the CMS Medicare Coverage Database.
When did NCD 240.8 take effect?
The current version (1) is effective 09/25/2007, implemented 01/07/2008, published in transmittal 78. This is the only published version.
Does a Local Coverage Determination override NCD 240.8?
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.