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A national coverage determination (NCD) [1] is a United States nationwide determination of whether Medicare will pay for an item or service. [2] It is a form of utilization management and forms a medical guideline on treatment.
In 1989 the Health Care Financing Administration formalized this as a National Coverage Determination (NCD), 140.3, Transsexual Surgery that made transsexual surgery ineligible from public insurance on the basis of the NCTCH report. [2] [4] [8] [12] The ACLU submitted letters and affidavits challenging the NCD. [13] The NCD stated:
Utilization management is "a set of techniques used by or on behalf of purchasers of health care benefits to manage health care costs by influencing patient care decision-making through case-by-case assessments of the appropriateness of care prior to its provision," as defined by the Institute of Medicine [1] Committee on Utilization Management by Third Parties (1989; IOM is now the National ...
National coverage determination, American public healthcare guidance Neurocognitive disorder , a class of mental illness Organisations in government and politics
The Centers for Medicare & Medicaid Services (CMS) is a federal agency within the United States Department of Health and Human Services (HHS) that administers the Medicare program and works in partnership with state governments to administer Medicaid, the Children's Health Insurance Program (CHIP), and health insurance portability standards.
Medicaid coverage gap; Medicaid Drug Rebate Program; Medicaid Home and Community-Based Services Waivers; Medicaid waiver; Medical necessity; Medical savings account (United States) Medically indigent adult; Medically Unlikely Edit; Medicare Advantage; Medicare and Medicaid Extenders Act of 2010; Medicare for All Act; Medicare Fraud Strike Force
Shuren was responsible for the development of Medicare national coverage determinations for drugs, biologics, and non-implantable devices, while director of the Division of Items and Devices, Coverage and Analysis Group at the Centers for Medicare and Medicaid Services. [1]
Level II codes are maintained by the US Centers for Medicare and Medicaid Services (CMS). There is some overlap between HCPCS codes and National Drug Code (NDC) codes, with a subset of NDC codes also in HCPCS, and vice versa. The CMS maintains a crosswalk from NDC to HCPCS in the form of an Excel file. The crosswalk is updated quarterly. [2]