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NCD Manual section 80: Eye

Section 80 of the Medicare National Coverage Determinations Manual (Pub. 100-03, chapter 1, part 1) holds 14 National Coverage Determinations on eye. Each binds every Medicare Administrative Contractor; this page lists them with their effective dates, the local policies that cite them and the contractor articles that turn them into claim edits.

Compiled from CMS files by the QuickIntell RCM Editorial Team · Data effective · Method: reference methodology · Report a data correction

Data currency: Medicare Coverage Database NCDs: API snapshot September 27, 2026 (effective September 20, 2026); Medicare Coverage Database billing and coding articles: MCD release October 8, 2026 (effective October 4, 2026). Next CMS release: weekly, every Thursday.

NCDs in the section
14
10 with a full reference page
Laboratory NCDs
0
Cited by local policies
10
48 LCD citations
With contractor articles
9
19 articles
Coverage analyses linked
20
Newest effective date
2013-04-03
NCD 80.3.1

Every NCD in section 80

Local policies counts the active LCDs that list the NCD as related; contractor articles counts the current Medicare Coverage Database articles that name it. NCDs with an indexed reference page are linked; the others are listed by number and title.

National Coverage Determinations in NCD Manual section 80, Eye
NCDTitleBenefit categoryEffectiveLocal policiesContractor articles
80.1Hydrophilic Contact Lens For Corneal BandageIncident to a physician's professional Service, Outpatient Hospital Services Incident to a Physician's Servicelongstanding—1
80.2Photodynamic TherapyPhysicians' Services2013-04-033—
80.2.1Ocular Photodynamic Therapy (OPT)Physicians' Services2013-04-033—
80.3Photosensitive DrugsDrugs and Biologicals2013-04-0331
80.3.1VerteporfinDrugs and Biologicals2013-04-032—
80.4Hydrophilic Contact LensesProsthetic Deviceslongstanding11
80.5Scleral ShellProsthetic Deviceslongstanding——
80.6Intraocular PhotographyPhysicians' Services1979-09-0171
80.7Refractive KeratoplastyNo Benefit Category1997-05-01——
80.8Endothelial Cell PhotographyDiagnostic Tests (other)1992-08-3163
80.9Computer Enhanced PerimetryDiagnostic Tests (other)1984-02-1572
80.10Phaco-Emulsification Procedure - Cataract ExtractionPhysicians' Serviceslongstanding106
80.11VitrectomyAmbulatory Surgical Center Facility Services, Physicians' Services2006-06-19—1
80.12Intraocular Lenses (IOLs)Prosthetic Devices1997-05-1963

What the section covers and how to read it

The NCD Manual groups national policies by body system or service type, and the section number is the first part of every NCD number in it. Section 80 covers eye. Most of its NCDs fall under the Physicians' Services (4), Prosthetic Devices (3), Diagnostic Tests (other) (2) benefit categories, which decide whether Medicare can pay for the item at all before the NCD's clinical criteria are applied. Effective dates in the section run from 1979-09-01 (NCD 80.6) to 2013-04-03 (NCD 80.3.1); 4 NCDs are longstanding policies for which CMS has not posted the effective date of the current version. A claim is judged against the version in force on the date of service, so the effective date and the revision history on each NCD page matter as much as the criteria.

Read an NCD in three layers. The item or service description says what the policy is about; the indications and limitations say when Medicare covers it, often with documentation, setting or frequency conditions; and the contractor articles say how the claim must be coded for the national criteria to be applied automatically. In this section 9 NCDs have such contractor articles, listed on each NCD page under "How MACs bill" with their covered ICD-10-CM codes. Where a contractor has also written a Local Coverage Determination that cites the NCD, the LCD adds local documentation and coding detail but cannot narrow or widen the national coverage.

Local policies and contractor articles

10 of the 14 NCDs in this section are cited by active Local Coverage Determinations, 48 citations in all; 9 have contractor billing articles (19 articles across the Medicare Administrative Contractors). To see what applies to a claim, open the NCD, then the local policy and article of the contractor that processes it: the LCD list carries every active local policy, the LCD lookup guide explains which contractor covers which state, and the code-and-diagnosis checker tests one procedure code and one ICD-10-CM code against every article that applies in a state. A denial under an NCD returns CARC 50 with remark N386.

The most searched NCD in this section is NCD 80.11 Vitrectomy, at about 10 US Google searches a month for its number.

Other sections of the NCD Manual

Chapter 1 of the manual is published in four parts on cms.gov; every section with a current NCD has its own page here.

Where QuickIntell fits in coverage checks

QuickAuth coordinates requirement checks, documentation, submission and status tracking for prior authorization with human review, so national and local coverage criteria are looked at before the service. QuickRCM picks up the claim and any coverage denial afterwards.

Frequently asked questions

Which NCDs are in NCD Manual section 80?

Section 80, Eye, holds 14 National Coverage Determinations in the current Medicare Coverage Database: 80.1 Hydrophilic Contact Lens For Corneal Bandage; 80.2 Photodynamic Therapy; 80.2.1 Ocular Photodynamic Therapy (OPT); 80.3 Photosensitive Drugs; 80.3.1 Verteporfin; 80.4 Hydrophilic Contact Lenses; 80.5 Scleral Shell; 80.6 Intraocular Photography; and 6 more listed on this page.

How are NCD numbers assigned?

An NCD number is its place in chapter 1 of the NCD Manual: the part before the dot is the section (80 here), and the rest orders the policies inside it. Section 80 is in part 1 of the chapter. The number stays with the policy when CMS revises it; each revision gets a new version and transmittal instead.

Do Medicare contractors add local rules to section 80 NCDs?

10 of the 14 NCDs are cited by at least one active Local Coverage Determination, and 9 have contractor articles that implement them in the Medicare Coverage Database. A local policy may add documentation and coding detail but may not contradict the national determination.

How current is this list?

It is rebuilt from the CMS Coverage API NCD records and the weekly Medicare Coverage Database article export. The most recent effective date in the section is 2013-04-03 (NCD 80.3.1); 4 are longstanding NCDs whose current-version effective date CMS has not posted.

Sources

Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-10. Verify against the primary file before billing or contracting decisions. The reference methodology explains how each figure is computed from these files.

Disclaimer

NCD titles, dates and counts are compiled from the CMS Coverage API and the Medicare Coverage Database export as an operational reference. Coverage depends on the full policy text, the claim and the contractor; verify against the current NCD on cms.gov. Not legal, clinical or billing advice.

Found a figure that does not match the CMS file? Report a data correction with the CMS file and the value you expected; the request reaches the editorial team through the contact form.