The Centers for Medicare & Medicaid Services (CMS) makes changes to the services covered by Medicare. These changes are updated via National Coverage Determinations (NCDs). Here, you can learn about CMS’s NCD process and view summaries of recent NCDs – each with the effective date listed and a link to the full NCD.
Effective 8/30/2016, The Centers for Medicare & Medicaid Services (CMS) is not issuing a National Coverage Determination (NCD) at this time on gender reassignment surgery for Medicare beneficiaries with gender dysphoria because the clinical evidence is inconclusive for the Medicare population. For Medicare beneficiaries enrolled in Medicare Advantage (MA) plans, the initial determination of whether or not surgery would be reasonable and necessary will be made by the MA plans. (posted on 8/30/2016) Decision Memo for Gender Dysphoria and Gender Reassignment Surgery (CAG-00446N)
Effective 9/28/2016, Medicare will cover a screening test for hepatitis B (HBV) infection in nonpregnant adolescents and adults without symptoms of the infection who are determined by their primary care providers to be at high risk. In addition, Medicare has determined that repeated screening would be appropriate annually only for beneficiaries with continued high risk who do not receive the hepatitis B vaccine. (Posted 09/28/2016) Decision Memo for Screening for Hepatitis B (HBV) Infection
Effective 12/7/2016, The Centers for Medicare & Medicaid Services (CMS) has determined that percutaneous image-guided lumbar decompression (PILD) for lumbar spinal stenosis (LSS) is not reasonable and necessary under section 1862(a)(1)(A) of the Social Security Act. Medicare will cover PILD procedures in certain cases when provided in a CMS-approved prospective and longitudinal clinical research study. (Posted December 7, 2016) Decision Memo for Percutaneous Image-guided Lumbar Decompression for Lumbar Spinal Stenosis (CAG-00433R)
Effective 8/29/2017, The Centers for Medicare & Medicaid Services (CMS) has signaled its intent to cover leadless pacemakers through Coverage with Evidence Development (CED). Medicare covers leadless pacemakers when procedures are performed in certain FDA approved studies. Medicare will cover, in CMS-approved prospective long-term studies, leadless pacemakers that are used in accordance with the FDA approved label for devices that have either:
An associated ongoing FDA approved post-approval study; or
Completed an FDA post-approval study (Posted January 18, 2017)
Effective 4/3/2017, The Centers for Medicare and Medicaid Services (CMS) has amended its previous National Coverage Determination (NCD) for HBO therapy by removing Section C from the NCD, which previously considered the application of topical oxygen for chronic wounds as nationally non-covered. The coverage of topical oxygen for this purpose will be determined by the local Medicare Administrative Contractors. (Posted 4/3/2017) Decision Memo for Hyperbaric Oxygen (HBO) Therapy (Section C, Topical Oxygen
Effective for services performed on or after 5/25/2017, The Centers for Medicare & Medicaid Services (CMS) will cover supervised exercise therapy (SET) for beneficiaries with intermittent claudication (IC) for the treatment of symptomatic peripheral artery disease (PAD) when provided in a qualified SET program and the beneficiary’s condition meets certain criteria. (Posted 5/25/2017) Decision memo for Supervised Exercise Therapy for Peripheral Artery Disease (CAG-00449N)
Teal Premier, a product of Care N’ Care Insurance Company of North Carolina, Inc., is a Medicare Advantage organization with a Medicare contract. Enrollment in Teal Premier depends on contract renewal. You must continue to pay your Medicare Part B premium. This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums and/or copayments/coinsurance may change on January 1 of each year. The Formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary.
Teal Premier, 7800 McCloud Road, Suite 100, Greensboro, North Carolina 27409.
To learn more, please call 1-888-272-0202 (TTY 711) from October 1 – March 31, 8 a.m. to 8 p.m. ET, seven days a week, or April 1 – September 30, 8 a.m. to 8 p.m. ET, Monday through Friday.