National Coverage Determinations

Posted on December 10, 2020

As a Medicare health plan, Health New England Medicare Advantage covers all services required by Original Medicare. We only make mid-year benefit changes when Medicare changes its coverage rules. When this happens, Medicare issues a National Coverage Determination (NCD) explaining whether Medicare will pay for an item or service. Below are the recent changes from the past year:

Next Generation Sequencing (NGS) for Medicare Beneficiaries with Advanced Cancer – Effective January 27, 2020
The Centers for Medicare & Medicaid Services (CMS) has determined that Next Generation Sequencing (NGS) as a diagnostic laboratory test is reasonable and necessary and covered nationally, when performed in a CLIA-certified laboratory, when ordered by a treating physician and when certain requirements are met. (Read more at: https://www.cms.gov/medicare-coverage-database/details/ncd-details.aspx?NCDId=372)

Decision Memo for Acupuncture for Chronic Low Back Pain (CAG-00452N) – Effective January 21, 2020
The Centers for Medicare & Medicaid Services (CMS) will cover acupuncture for chronic low back pain under section 1862(a)(1)(A) of the Social Security Act. Up to 12 visits in 90 days are covered for Medicare beneficiaries under the following circumstances. (Read more at: https://www.cms.gov/medicare-coverage-database/details/ncd-details.aspx?NCDId=373)

You can also find a listing of recent NCDs on our website at healthnewengland.org/medicare/members.

Categories: MemberMatters - Medicare