Key facts for NCD 260.2
- Benefit category
- Inpatient Hospital Services, Physicians' Services
- Effective date
- 04/12/1991
- Implemented 09/01/1991
- Transmittal
- Transmittal 52
- Versions published
- 1
- Manual chapter
- 260
- NCD Manual (Pub. 100-03)
TL;DR
NCD 260.2 sets Medicare's national policy for pediatric liver transplantation under the benefit category "Inpatient Hospital Services, Physicians' Services", effective 04/12/1991 and implemented 09/01/1991. Liver transplantation is covered for children (under age 18) with extrahepatic biliary atresia or any other form of end stage liver disease, except that coverage is not provided for children with a malignancy extending beyond the margins of the liver or… It has been revised once since publication and binds every Medicare Administrative Contractor nationally.
Indications and limitations of coverage
Liver transplantation is covered for children (under age 18) with extrahepatic biliary atresia or any other form of end stage liver disease, except that coverage is not provided for children with a malignancy extending beyond the margins of the liver or those with persistent viremia.
Liver transplantation is covered for Medicare beneficiaries when performed in a pediatric hospital that performs pediatric liver transplants if the hospital submits an application which CMS approves documenting that:
The hospital's pediatric liver transplant program is operated jointly by the hospital and another facility that has been found by CMS to meet the institutional coverage criteria in the "Federal Register" notice of April 12, 1991;
• The unified program shares the same transplant surgeons and quality assurance program (including oversight committee, patient protocol, and patient selection criteria); and
• The hospital is able to provide the specialized facilities, services, and personnel that are required by pediatric liver transplant patients.
Text reproduced from the CMS Medicare Coverage Database record for NCD 260.2 version 1. View the original on cms.gov.
Revision history
09/1991 - Reiterated coverage policy and provided instructions for applying to become an approved pediatric liver transplant facility. Effective date 04/12/1991. (TN 52)
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 260.2
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 260.2
What does NCD 260.2 cover?
Liver transplantation is covered for children (under age 18) with extrahepatic biliary atresia or any other form of end stage liver disease, except that coverage is not provided for children with a malignancy extending beyond the margins of the liver or those with persistent viremia. The full indications and limitations are reproduced on this page from the CMS Medicare Coverage Database.
When did NCD 260.2 take effect?
The current version (1) is effective 04/12/1991, implemented 09/01/1991, published in transmittal 52. This is the only published version.
Does a Local Coverage Determination override NCD 260.2?
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.