Key facts for NCD 280.10
- Benefit category
- Artificial Legs, Arms, and Eyes
- Effective date
- This is a longstanding national coverage determination. The effective date of this version has not been posted.
- Transmittal
- Transmittal 36
- Versions published
- 1
- Manual chapter
- 280
- NCD Manual (Pub. 100-03)
TL;DR
NCD 280.10 sets Medicare's national policy for prosthetic shoe under the benefit category "Artificial Legs, Arms, and Eyes", effective This is a longstanding national coverage determination. The effective date of this version has not been posted.. A prosthetic shoe (a device used when all or a substantial portion of the front part of the foot is missing) can be covered as a terminal device; i.e., a structural supplement replacing a totally or substantially absent hand or foot. The coverage of… It has been revised once since publication and binds every Medicare Administrative Contractor nationally.
Indications and limitations of coverage
A prosthetic shoe (a device used when all or a substantial portion of the front part of the foot is missing) can be covered as a terminal device; i.e., a structural supplement replacing a totally or substantially absent hand or foot. The coverage of artificial arms and legs includes payment for terminal devices such as hands or hooks even though the patient may not require an artificial limb. The function of the prosthetic shoe is quite distinct from that of excluded orthopedic shoe and supportive foot devices which are used by individuals whose feet, although impaired, are essentially intact. (Section 1862(a)(8) of the Act excludes payment for orthopedic shoes or other supportive devices for the feet.)
Text reproduced from the CMS Medicare Coverage Database record for NCD 280.10 version 1. View the original on cms.gov.
Revision history
5/1989 - Added statutory authority citation. Effective date NA. (TN 36)
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 280.10
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 280.10
What does NCD 280.10 cover?
A prosthetic shoe (a device used when all or a substantial portion of the front part of the foot is missing) can be covered as a terminal device; i.e., a structural supplement replacing a totally or substantially absent hand or foot. The coverage of artificial arms and legs includes payment for terminal devices such as hands or hooks even though the patient may not require an artificial limb. The function of the… The full indications and limitations are reproduced on this page from the CMS Medicare Coverage Database.
When did NCD 280.10 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., published in transmittal 36. This is the only published version.
Does a Local Coverage Determination override NCD 280.10?
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.