National coverage determinations (NCDs) are made through an evidence-based process, with opportunities for public participation. In some cases, CMS' own research is supplemented by an outside technology assessment and/or consultation with the Medicare Evidence Development & Coverage Advisory Committee (MEDCAC). In the absence of a national coverage policy, an item or service may be covered at the discretion of the Medicare contractors based on a local coverage determination (LCD).
Requesting an NCD is a formal process outlined in the August 7, 2013 Federal Register Notice (PDF). We strongly encourage those wishing to request an NCD to read the information below and refer to the FR notice for additional information on what constitutes a complete, formal request. Additionally, the FR notice contains information about initiating informal contact with CMS prior to the submission of a complete, formal request.
In general, we will consider a request to be a complete, formal request if the following conditions are met:
- The request is in writing, is not marked as a draft, and is clearly identified as “A Formal Request for a National Coverage Determination.”
- The request clearly identifies the statutorily-defined benefit category to which the requester believes the item or service applies and contains enough information for us to make a benefit category determination.
- The request is accompanied by sufficient, supporting evidentiary documentation.
- The information provided addresses relevance, usefulness, or the medical benefits of the item or service to the Medicare population.
- The information fully explains the design, purpose, and method of using the item or service for which the request is made.
Requests for NCDs may be submitted electronically to NCDRequest@cms.hhs.gov.
Requests may also be submitted to the Centers for Medicare & Medicaid Services; Director, Coverage and Analysis Group; 7500 Security Boulevard; Baltimore, MD 21244.