CMS Pub. 100-16, ch. 4, § 90.6

Generally, legislative changes to Medicare coverage rules are established by statute and

implemented through notice-and-comment rulemaking. For example, if Medicare Part B

coverage is affected, the changes are usually included in the annual Medicare Physician

Fee Schedule (MPFS) proposed and final rules, published in the Federal Register every

summer and fall, respectively. These rules are codified in the Code of Federal

Regulations. Medicare manual guidance corresponding to legislative changes in benefits

may also be released in the Medicare Benefit Policy Manual (Pub. 100-02) and/or the

Medicare Claims Processing Manual (Pub. 100-04).

Implementation of coverage changes resulting from the NCD process and all related

changes to original Medicare claims processing are made through Change Requests

(CRs) and Transmittals (TRs) that also are used to update the Medicare National

Coverage Determinations Manual (Pub. 100-03) and the Medicare Claims Processing

Manual (Pub. 100-04).

Although MA plans have not been required to use original Medicare claims processing

systems, MAOs must follow the coverage instructions in the original Medicare CRs/TRs.

We also encourage plans to use claims processing guidance as a source of information

that will support their implementation of the new benefit/service or other change in

coverage.

The following Internet resources provide information on NCDs and LCDs:

The Medicare Coverage webpage located at:

http://www.cms.hhs.gov/center/coverage.asp has links that:

• Provide a listing of all NCDs;

• Provide a listing of all National Coverage Analyses (NCAs) and final Decision

Memos;

• Provide an index of Local Coverage Determinations (LCDs);

• Enable users to subscribe to the CMS Coverage Listserv and receive weekly

notifications when national coverage documents are updated, such as national

coverage analyses (NCAs) and national coverage determinations (NCDs). Listserv

subscribers also receive special updates, including CMS announcements of new

topics opened for national decision, posting of decision memos, and posting of final

technology assessment (TA) reports;

• Provide a list of all email coverage updates sorted by year; and

• Enable users to search the database.

Both pending and closed coverage determinations are listed. For each coverage topic

CMS provides a staff name and e-mail link so that interested individuals can send

questions and provide feedback.

The Medicare National Coverage Determinations Manual, Publication 100-03,

accessible at: http://www.cms.gov/Regulations-and-

Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs.html, includes the Medicare

national coverage determinations.

Program Transmittals and Change Requests transmit CMS’ new policies and

procedures on new coverage determinations and Medicare benefits. Links to the Program

Transmittals and Change Requests can be found at http://www.cms.gov/Regulations-and-

Guidance/Guidance/Transmittals/index.html; and

Medicare Internet-Only Manuals, located at http://www.cms.gov/Regulations-and-

Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs.html. These manuals,

including the Benefit Policy Manual and Claims Processing Manuals, as described above,

present information on Medicare coverage of items and services and claims processing.

Changes to these manuals are released through Program Transmittals and Change

Requests.