General Rules for NCDs

90.3 – General Rules for NCDs (Rev. 121, Issued: 04-22-16, Effective: 04-22-16, Implementation: 04-22-16) Medicare coverage policies specify which items and services are covered (or not covered) under Part A or Part B of the Medicare program and under what circumstances (including the clinical criteria under which the item or service must be covered). Medicare coverage policies have several sources: • NCDs made by CMS; • Local Coverage Determinations (LCDs); • Legislative changes in benefits applied through notice and comment rulemaking (often codifying the changes in the Code of Federal Regulations); and • Other coverage guidelines and instructions issued by CMS (e.g., Change requests and Program Transmittals). As indicated in section 10.2 above, MA plans must provide all items and services classified as original Medicare-covered benefits. In applying this rule to NCDs, different rules apply depending on whether the significant cost criterion, described above in section 90.3, has been met.