Key facts for NCD 80.1
- Benefit category
- Incident to a physician's professional Service, Outpatient Hospital Services Incident to a Physician's Service
- Effective date
- This is a longstanding national coverage determination. The effective date of this version has not been posted.
- Transmittal
- Transmittal 73
- Versions published
- 1
- Manual chapter
- 80
- NCD Manual (Pub. 100-03)
TL;DR
NCD 80.1 sets Medicare's national policy for hydrophilic contact lens for corneal bandage under the benefit category "Incident to a physician's professional Service, Outpatient Hospital Services Incident to a Physician's Service", effective This is a longstanding national coverage determination. The effective date of this version has not been posted.. Payment may be made under §1861(s)(2) of the Social Security Act for a hydrophilic contact lens approved by the Food and Drug Administration (FDA) and used as a supply incident to a physician’s service. Payment for the lens is included in the payment for the… It has been revised once since publication and binds every Medicare Administrative Contractor nationally.
Item or service described
Some hydrophilic contact lenses are used as moist corneal bandages for the treatment of acute or chronic corneal pathology, such as bullous keratopathy, dry eyes, corneal ulcers and erosion, keratitis, corneal edema, descemetocele, corneal ectasis, Mooren's ulcer, anterior corneal dystrophy, neurotrophic keratoconjunctivitis, and for other therapeutic reasons.
Indications and limitations of coverage
Payment may be made under §1861(s)(2) of the Social Security Act for a hydrophilic contact lens approved by the Food and Drug Administration (FDA) and used as a supply incident to a physician’s service. Payment for the lens is included in the payment for the physician’s service to which the lens is incident. Medicare Administrative Contractors are authorized to accept an FDA letter of approval or other FDA published material as evidence of FDA approval. (See §80.4 for coverage of a hydrophilic contact lens as a prosthetic device.)
Text reproduced from the CMS Medicare Coverage Database record for NCD 80.1 version 1. View the original on cms.gov.
Revision history
12/1994 - Explained how payment provided when hydrophilic contact lenses are furnished incident to physician's services. Effective date NA. (TN 73)
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 80.1
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 80.1
What does NCD 80.1 cover?
Payment may be made under §1861(s)(2) of the Social Security Act for a hydrophilic contact lens approved by the Food and Drug Administration (FDA) and used as a supply incident to a physician’s service. Payment for the lens is included in the payment for the physician’s service to which the lens is incident. Medicare Administrative Contractors are authorized to accept an FDA letter of approval or other FDA… The full indications and limitations are reproduced on this page from the CMS Medicare Coverage Database.
When did NCD 80.1 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 73. This is the only published version.
Does a Local Coverage Determination override NCD 80.1?
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.