National Coverage Determinations

The Centers for Medicare & Medicaid Services (CMS) makes changes to the services that are covered by Medicare. These changes are updated via National Coverage Determinations (NCDs). The following NCDs have been finalized in the past 12 months.

Noninvasive Positive Pressure Ventilation (NIPPV) in the Home for the Treatment of Chronic Respiratory Failure (CRF) Consequent to Chronic Obstructive Pulmonary Disease (COPD) 

Effective June 9, 2025 : NCD 240.3, CMS announced coverage for in the home a RAD with backup rate feature to deliver high intensity noninvasive ventilation (NIV) as treatment for patients with chronic respiratory failure (CRF) consequent to chronic obstructive pulmonary disease (COPD). A RAD with backup rate feature is covered in the home for an initial 6-month period for patients with COPD when all the following criteria are met: Patient and Usage Criteria

Reference NCD - Noninvasive Positive Pressure Ventilation (NIPPV) in the Home for the Treatment of Chronic Respiratory Failure (CRF) Consequent to Chronic Obstructive Pulmonary Disease (COPD) (240.9)

Pre-Exposure Prophylaxis (PrEP) for Human Immunodeficiency Virus (HIV) Prevention

Effective 04/07/2025, Pre-exposure prophylaxis (PrEP) involves the use of antiretroviral drugs to decrease the risk of acquiring human immunodeficiency virus (HIV). Under § 1861(ddd)(1) of the Social Security Act (the Act), the Centers for Medicare & Medicaid Services (CMS) has the authority to add coverage of “additional preventive services” through the Medicare national coverage determination (NCD) process if certain statutory requirements are met: (1) reasonable and necessary for the prevention or early detection of illness or disability, (2) recommended with a grade of A or B by the United States Preventive Services Task Force (USPSTF), and (3) appropriate for individuals entitled to benefits under Part A or enrolled under Part B.

Revision 8/2025- The purpose of this Change Request (CR) is to provide a maintenance update of ICD-10 coding changes specific to NCDs. (TN 13375 ) (CR14197)

Reference - NCD - Pre-Exposure Prophylaxis (PrEP) for Human Immunodeficiency Virus (HIV) Prevention (210.15)

Transcatheter Edge-to-Edge Repair for Tricuspid Valve Regurgitation (TTEER) 

Effective July 2, 2025: NCD 20.38 -The Centers for Medicare & Medicaid Services (CMS) covers Tricuspid Transcatheter Edge to-Edge Repair (TTEER) for treatment of symptomatic Tricuspid Regurgitation (TR) under the Coverage with Evidence Development (CED) according to the criteria outlined in the National Coverage Determination (NCD) manual, Chapter 1, Section 20.38. 

Cardiac Contractility Modulation (CCM) for Heart Failure (HF)

Effective October 28, 2025, CMS covers CCM used for the treatment of HF under Coverage with Evidence Development (CED) according to the criteria outlined in the National Coverage Determination (NCD) manual, chapter 1, section 20.39. Consistent with section 1142 of the Act, Agency for Healthcare Research and Quality (AHRQ) supports clinical research studies that CMS determines meet all the criteria and standards identified above. CCM used for the treatment of HF is not covered for patients outside of a CMS-approved study. Nothing in this NCD would preclude coverage of CCM through NCD 310.1 (Clinical Trial Policy) or through the Investigational Device Exemption (IDE) Policy.

Renal Denervation (RDN) for Uncontrolled Hypertension

Updated 2/16/2026

Transmittal 13612 issued January 30, 2026, is being rescinded and replaced by Transmittal 13640, dated February 13, 2026, to include the correct version of the NCD 20.40 Renal Denervation for Uncontrolled Hypertension Spreadsheet, where principal language for ICD-10 CM codes is removed. This correction does not make any revisions to Pub. 100-03.
All other information remains the same.

Updated 2/2/2026:

Transmittal 13522 issued December 11, 2025, is being rescinded and replaced by Transmittal 13612, dated January 30, 2026, to update Transmittal Pub. 100-04 Business Requirements (BRs) to include outpatient Type of Bill (TOB) and Place of Service (POS). The BRs will be revised to ADD this setting and modify associated BRs editing to be performed in the correct setting. Clarifying language has also been updated for ICD-10 diagnosis codes. The associated changes will be made in the claims processing manual and updated in the NCD spreadsheet. Additionally, BR 14302-04.13 has been added. This correction does not make any revisions to Pub. 100-03
All other information remains the same.

CMS advised that effective October 28, 2025, there is coverage for radiofrequency renal denervation (rfRDN) and ultrasound renal denervation (uRDN) (collectively, RDN) for uncontrolled hypertension under Coverage with Evidence Development (CED) according to the criteria outlined in NCD manual, Chapter 1, Section 20.40.

Consistent with section 1142 of the Act, the Agency for Healthcare Research and Quality (AHRQ) supports clinical research studies that CMS determines meet all the criteria and standards identified above.

Renal denervation (RDN) for uncontrolled hypertension) is not covered for patients outside of a CMS approved study.