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National Coverage Determination (NCD) for Abortion (140.1)

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Benefit Category
Physicians' Services

Note: This may not be an exhaustive list of all applicable Medicare benefit categories for this item or service.

Indications and Limitations of Coverage

CIM 35-99

Abortions are not covered Medicare procedures except:

  1. If the pregnancy is the result of an act of rape or incest; or
  2. In the case where a woman suffers from a physical disorder, physical injury, or physical illness, including a life-endangering physical condition caused by or arising from the pregnancy itself, that would, as certified by a physician, place the woman in danger of death unless an abortion is performed.

Transmittal Number

48

Revision History

03/1999 - Restricted coverage to pregnancies resulting from rape or incest, or that endanger the life of the mother. Effective date NA. Restrictions are included in section 508 and 509 of the Omnibus Consolidated and Emergency Supplemental Appropriations Act for fiscal year 1999. (TN 108) (CR 778)

03/2006 - Technical Corrections to the NCD Manual. Effective/Implementation Date: 06/19/2006. (TN 48) (CR4278)


Other Versions
  • Abortion - Version 1, Effective between 10/1/1998 - 6/19/2006
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CPT only copyright 2002-2011 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association. Applicable FARS/DFARS Apply to Government Use. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.
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