Key facts for NCD 70.5
- Benefit category
- Diagnostic Laboratory Tests, Diagnostic Tests (other), Diagnostic X-Ray Tests
- Effective date
- 09/01/1979
- Transmittal
- n/a
- Versions published
- 1
- Manual chapter
- 70
- NCD Manual (Pub. 100-03)
TL;DR
NCD 70.5 sets Medicare's national policy for hospital and skilled nursing facility admission diagnostic procedures under the benefit category "Diagnostic Laboratory Tests, Diagnostic Tests (other), Diagnostic X-Ray Tests", effective 09/01/1979. These instructions describe the application of the reasonable and necessary payment exclusion to diagnostic procedures, such as chest x-rays, urinalysis, etc. provided to patients upon admission to a hospital or skilled nursing facility. It has been revised once since publication and binds every Medicare Administrative Contractor nationally.
Indications and limitations of coverage
These instructions describe the application of the reasonable and necessary payment exclusion to diagnostic procedures, such as chest x-rays, urinalysis, etc. provided to patients upon admission to a hospital or skilled nursing facility.
The major factors which support a determination that a diagnostic procedure performed as part of the admitting procedure to a hospital or skilled nursing facility is reasonable and necessary, are:
• The test is specifically ordered by the admitting physician (or a hospital or skilled nursing facility staff physician having responsibility for the patient where there is no admitting physician): i.e., it is not furnished under the standing orders of a physician for his patients;
• The test is medically necessary for the diagnosis or treatment of the individual patient’s condition; and
• The test does not unnecessarily duplicate the same test performed on an outpatient basis prior to admission or performed in connection with a recent hospital or skilled nursing facility admission.
Where the Medicare Administrative Contractor has not already done so, consult with the Quality Improvement Organizations (QIOs) to obtain information gathered by the QIOs on a sample basis as to whether x-rays and diagnostic tests are being specifically ordered as described under subsection (A).
Text reproduced from the CMS Medicare Coverage Database record for NCD 70.5 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 70.5
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 70.5
What does NCD 70.5 cover?
These instructions describe the application of the reasonable and necessary payment exclusion to diagnostic procedures, such as chest x-rays, urinalysis, etc. provided to patients upon admission to a hospital or skilled nursing facility. The full indications and limitations are reproduced on this page from the CMS Medicare Coverage Database.
When did NCD 70.5 take effect?
The current version (1) is effective 09/01/1979. This is the only published version.
Does a Local Coverage Determination override NCD 70.5?
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.