Medicare National Coverage Determinations

Medicare covers CRT (and CRT-D) for heart failure patients meeting LVEF, QRS duration, and NYHA class criteria with documented optimal medical therapy.

Medicare covers ICDs for both primary (no prior cardiac arrest) and secondary (post-cardiac arrest) prevention with specific criteria around LVEF, NYHA class, and prior MI timing.

Medicare covers TAVR for symptomatic aortic stenosis with FDA-approved device, multidisciplinary heart team evaluation, and Coverage with Evidence Development requirements.

Medicare covers DME meeting four criteria: durable (3+ years), used for medical purpose, not useful in absence of illness, appropriate for home use. NCD 280.1 contains the comprehensive reference list…

Medicare covers autologous and allogeneic stem cell transplantation (AuSCT, AlloSCT) for specific malignancies and rare conditions with strict criteria. Coverage was expanded in 2016 for myelofibrosis…

Medicare covers amyloid PET imaging for Alzheimer's via Coverage with Evidence Development (CED) since the 2024 NCD update, expanding from the prior single-scan-per-lifetime limit.

Medicare covers screening mammography annually for women 40+, and diagnostic mammography when clinically indicated.

Medicare covers cochlear implants for adult and pediatric patients with bilateral severe-to-profound sensorineural hearing loss demonstrating limited benefit from hearing aids.

Medicare covers up to 12 acupuncture sessions in 90 days for chronic low back pain (≥12 weeks duration), with up to 8 additional sessions if improvement demonstrated.

Medicare covers HIV screening for all Medicare beneficiaries aged 15-65 (and outside that range if increased risk) annually with no cost-sharing.

Medicare covers annual LDCT lung cancer screening for current and former smokers meeting USPSTF-aligned criteria with mandatory shared decision-making visit.

Medicare covers home O2 for chronic lung disease, hypoxemia-related conditions, with specific PaO2 / SpO2 / ABG criteria.

Medicare covers CPAP for OSA when diagnosed by appropriate sleep testing AND patient meets adherence criteria during 90-day trial period.

Medicare covers Roux-en-Y gastric bypass, laparoscopic sleeve gastrectomy, BPD-DS, and laparoscopic adjustable gastric banding for patients meeting BMI + comorbidity + behavioral criteria.