Persius/hicric huggingface dataset:
**

B.      Nationally Covered Indications

**

Pursuant to this national coverage determination (NCD), the off-label use of
clinical items and services, including the use of the studied drugs
oxaliplatin, irinotecan, cetuximab, or bevacizumab, are covered in specific
clinical trials identified by the Centers for Medicare & Medicaid Services
(CMS). The clinical trials identified by CMS for coverage of clinical items
and services are sponsored by the National Cancer Institute (NCI) and study
the use of one or more off-label uses of these four drugs in colorectal cancer
and in other cancer types. The list of identified trials is on the CMS Web
site at:
[http://www.cms.hhs.gov/coverage/download/id90b.pdf](https://www.cms.gov/Medicare/Coverage/DeterminationProcess/downloads/id90b.pdf).

**

C.      Other

**

This policy does not alter Medicare coverage for items and services that may
be covered or non-covered according to the existing national coverage policy
for Routine Costs in a Clinical Trial (NCD Manual section 310.1). Routine
costs will continue to be covered as well as other items and services provided
as a result of coverage of these specific trials in this policy. The basic
requirements for enrollment in a trial remain unchanged.

The existing requirements for coverage of oxaliplatin, irinotecan, cetuximab,
bevacizumab, or other anticancer chemotherapeutic agents for FDA-approved
indications or for indications listed in an approved compendium are not
modified.

MACs shall continue to make reasonable and necessary coverage determinations
under section 1861(t)(2)(B)(ii)(II) of the Act based on guidance provided by
the Secretary for medically accepted uses of off-label indications of
oxaliplatin, irinotecan, cetuximab, bevacizumab, or other anticancer
chemotherapeutic agents provided outside of the identified clinical trials
appearing on the CMS website noted above.
**1\. Rubidium 82 (Effective March 14, 1995)**

Effective for services performed on or after March 14, 1995, PET scans
performed at rest or with pharmacological stress used for noninvasive imaging
of the perfusion of the heart for the diagnosis and management of patients
with known or suspected coronary artery disease using the FDA-approved
radiopharmaceutical Rubidium 82 (Rb 82) are covered, provided the requirements
below are met:

  * The PET scan, whether at rest alone, or rest with stress, is performed in place of, but not in addition to, a single photon emission computed tomography (SPECT); or
  * The PET scan, whether at rest alone or rest with stress, is used following a SPECT that was found to be inconclusive. In these cases, the PET scan must have been considered necessary in order to determine what medical or surgical intervention is required to treat the patient. (For purposes of this requirement, an inconclusive test is a test(s) whose results are equivocal, technically uninterpretable, or discordant with a patient's other clinical data and must be documented in the beneficiary's file.)
  * For any PET scan for which Medicare payment is claimed for dates of services prior to July 1, 2001, the claimant must submit additional specified information on the claim form (including proper codes and/or modifiers), to indicate the results of the PET scan. The claimant must also include information on whether the PET scan was performed after an inconclusive noninvasive cardiac test. The information submitted with respect to the previous noninvasive cardiac test must specify the type of test performed prior to the PET scan and whether it was inconclusive or unsatisfactory. These explanations are in the form of special G codes used for billing PET scans using Rb 82. Beginning July 1, 2001, claims should be submitted with the appropriate codes.

**2\. Ammonia N-13 (Effective October 1, 2003)**

Effective for services performed on or after October 1, 2003, PET scans
performed at rest or with pharmacological stress used for noninvasive imaging
of the perfusion of the heart for the diagnosis and management of patients
with known or suspected coronary artery disease using the FDA-approved
radiopharmaceutical ammonia N-13 are covered, provided the requirements below
are met:

  * The PET scan, whether at rest alone, or rest with stress, is performed in place of, but not in addition to, a SPECT; or
  * The PET scan, whether at rest alone or rest with stress, is used following a SPECT that was found to be inconclusive. In these cases, the PET scan must have been considered necessary in order to determine what medical or surgical intervention is required to treat the patient. (For purposes of this requirement, an inconclusive test is a test whose results are equivocal, technically uninterpretable, or discordant with a patient's other clinical data and must be documented in the beneficiary's file.)

**(This NCD last reviewed March 2005.)**
**220.6.3 - FDG PET for Esophageal Cancer (RETIRED)  
(Rev.11892; Issued: 03-09-23; Effective: 04-10-23; Implementation: 04-10-23)**

Please note section 220.6.3 has been removed from the NCD Manual and replaced
with section 220.6.17 _effective April 3, 2009._
Beginning July 1, 2001, Medicare covers FDG-PET for pre-surgical evaluation
for the purpose of localization of a focus of refractory seizure activity.

Limitations: Covered only for pre-surgical evaluation.

Documentation that these conditions are met should be maintained by the
referring physician in the beneficiary's medical record, as is normal business
practice.

(This NCD last reviewed June 2001.)
**220.6.14 - FDG PET for Brain, Cervical, Ovarian, Pancreatic, Small Cell
Lung, and Testicular Cancers (RETIRED)  
(Rev. 11892; Issued: 03-09-23; Effective: 04-10-23; Implementation:
04-10-23)**

Please note section 220.6.14 has been removed from the NCD Manual and replaced
with section 220.6.17 _effective April 3, 2009._
**220.6.15 - FDG PET for All Other Cancer Indications Not Previously Specified
(RETIRED)  
(Rev.11892; Issued: 03-09-23; Effective: 04-10-23; Implementation: 04-10-23)**

Please note section 220.6.15 has been removed from the NCD Manual and replaced
with section 220.6.17 _effective April 3, 2009._
**220.6.10 - FDG PET for Breast Cancer (RETIRED)  
(Rev. 11892; Issued: 03-09-23; Effective: 04-10-23; Implementation:
04-10-23)**

Please note section 220.6.10 has been removed from the NCD Manual and replaced
with section 220.6.17 _effective April 3, 2009._
1. FDG PET is covered for the determination of myocardial viability following an inconclusive single photon emission computed tomography (SPECT) test from July 1, 2001, through September 30, 2002. Only full ring PET scanners are covered from July 1, 2001, through December 31, 2001. However, as of January 1, 2002, full and partial ring scanners are covered. 
  

  2. Beginning October 1, 2002, Medicare covers FDG PET for the determination of myocardial viability as a primary or initial diagnostic study prior to revascularization, or following an inconclusive SPECT. Studies performed by full and partial ring scanners are covered. 

Limitations: In the event a patient receives a SPECT test with inconclusive
results, a PET scan may be covered. However, if a patient receives a FDG PET
study with inconclusive results, a follow up SPECT test is not covered.

Documentation that these conditions are met should be maintained by the
referring physician in the beneficiary's medical record, as is normal business
practice.

(This NCD last reviewed September 2002.)
**220.6.4- FDG PET for Colorectal Cancer (RETIRED)  
(Rev. 11892; Issued: 03-09-23; Effective: 04-10-23; Implementation:
04-10-23)**

Please note section 220.6.4 has been removed from the NCD Manual and replaced
with section 220.6.17 _effective April 3, 2009._
**220.6.5 - FDG PET for Lymphoma (RETIRED)  
(Rev. 11892; Issued: 03-09-23; Effective: 04-10-23; Implementation:
04-10-23)**

Please note section 220.6.5 has been removed from the NCD Manual and replaced
with section 220.6.17 _effective April 3, 2009._
**220.6.2 - FDG PET for Lung Cancer (RETIRED)  
(Rev. 11892; Issued: 03-09-23; Effective: 04-10-23; Implementation:
04-10-23)**

Please note section 220.6.2 has been removed from the NCD Manual and replaced
with section 220.6.17 _effective April 3, 2009._
**220.6.11 - FDG PET for Thyroid Cancer (RETIRED)  
(Rev. 11892; Issued: 03-09-23; Effective: 04-10-23; Implementation:
04-10-23)**

Please note section 220.6.11 has been removed from the NCD Manual and replaced
with section 220.6.17 _effective April 3, 2009._
**220.6.12 - FDG PET for Soft Tissue Sarcoma (RETIRED)  
(Rev. 11892; Issued: 03-09-23; Effective: 04-10-23; Implementation:
04-10-23)**

Please note section 220.6.12 has been removed from the NCD Manual and replaced
with section 220.6.17 _effective April 3, 2009._
**220.6.6 - FDG PET for Melanoma (RETIRED)  
(Rev. 11892; Issued: 03-09-23; Effective: 04-10-23; Implementation:
04-10-23)**

Please note section 220.6.6 has been removed from the NCD Manual and replaced
with section 220.6.17 _effective April 3, 2009._
**220.6.7 - FDG PET for Head and Neck Cancers (RETIRED)  
(Rev. 11892; Issued: 03-09-23; Effective: 04-10-23; Implementation:
04-10-23)**

Please note section 220.6.7 has been removed from the NCD Manual and replaced
with section 220.6.17 _effective April 3, 2009._
**110.19 - Abarelix for the Treatment of Prostate Cancer (RETIRED)  
_(Rev. 11892; Issued: 03-09-23; Effective: 04-10-23;
Implementation:04-10-23)**

_

Effective January 1, 2021, the Centers for Medicare & Medicaid Services
determined that no national coverage determination (NCD) is appropriate at
this time for Abarelix for the Treatment of Prostate Cancer. In the absence of
an NCD, coverage determinations will be made by the Medicare Administrative
Contractors under 1862(a)(1)(A) of the Social Security Act.
**210.4- Smoking and Tobacco-Use Cessation Counseling (RETIRED)  
(Rev. 11892; Issued: 03-09-23; Effective: 04-10-23; Implementation:
04-10-23)**

Effective September 30, 2015 this section is deleted and the remaining NCD
entitled Counseling to Prevent Tobacco Use (210.4.1) remains effective.
**B. Nationally Covered Indications**

Effective for services performed between April 4, 2005, and May 28, 2013, the
Centers for Medicare & Medicaid Services makes the following determinations
regarding the use of aprepitant in the treatment of reducing chemotherapy-
induced emesis:

The evidence is adequate to conclude that the use of the oral antiemetic
three-drug combination of oral aprepitant (Emend), an oral 5HT3 antagonist,
and oral dexamethasone is reasonable and necessary for a specified patient
population. We have defined the patient population for which the use of the
oral antiemetic three-drug combination of oral aprepitant (Emend), an oral
5HT3 antagonist, and oral dexamethasone is reasonable and necessary as only
those patients who are receiving one or more of the following anti-cancer
chemotherapeutic agents:

  * Carmustine
  * Cisplatin
  * Cyclophosphamide
  * Dacarbazine
  * Mechlorethamine
  * Streptozocin
  * Doxorubicin
  * Epirubicin
  * Lomustine

Effective for services performed on or after May 29, 2013, the oral three-drug
regimen of oral aprepitant, an oral 5HT3 antagonist and oral dexamethasone is
reasonable and necessary for beneficiaries receiving, either singularly or in
combination with other drugs the following anticancer chemotherapeutic agents:

  * Alemtuzumab
  * Azacitidine
  * Bendamustine
  * Carboplatin
  * Carmustine
  * Cisplatin
  * Clofarabine
  * Cyclophosphamide
  * Cytarabine
  * Dacarbazine
  * Daunorubicin
  * Doxorubicin
  * Epirubicin
  * Idarubicin
  * Ifosfamide
  * Irinotecan
  * Lomustine
  * Mechlorethamine
  * Oxaliplatin
  * Streptozocin

The oral three drug regimen must be administered immediately before and within
48 hours after the administration of these chemotherapeutic agents.

**C. Nationally Noncovered Indications**

The evidence is adequate to conclude that aprepitant cannot function alone as
a full replacement for intravenously administered antiemetic agents for
patients who are receiving highly emetogenic chemotherapy and/or moderately
emetogenic chemotherapy. Medicare does not cover under Part B for oral
antiemetic drugs in antiemetic drug combination regimens that are administered
in part, via an oral route and in part, via an intravenous route. Medicare
does not cover under Part B aprepitant when it is used alone for anticancer
chemotherapy related nausea and vomiting.

**D. Other**

Medicare Administrative Contractors may determine coverage for other all-oral
three-drug antiemesis regimens of aprepitant or any other FDA approved oral
NK-1 antagonist in combination with an oral 5HT3 antagonist and oral
dexamethasone with the chemotherapeutic agents listed above, or any other
anticancer chemotherapeutic agents that are FDA approved and are defined as
highly or moderately emetogenic.

(Last revised May 2013)
**B. Nationally Covered Indications**

Not applicable.

**C. Nationally Non-Covered Indications**

Effective August 24, 2006, Cavernous Nerves Electrical Stimulation with penile
plethysmography is non-covered under Medicare. CMS reviewed the evidence and
determined that this test is not reasonable and necessary for Medicare
beneficiaries undergoing nerve-sparing prostatic or colorectal surgical
procedures.

**D. Other**

Also see [20.14, Plethysmograthy](https://www.cms.gov/medicare-coverage-
database/details/ncd-
details.aspx?NCDId=165&ncdver=1&DocID=20.14&kq=true&SearchType=Advanced&bc=EAAAAAgAAAAA&).

(This NCD last reviewed September 2006.)
**220.6.16 - FDG PET for Infection and Inflammation (RETIRED)  
(Rev. 11892; Issued: 03-09-23; Effective: 04-10-23; Implementation:
04-10-23)**

Effective January 1, 2021, the Centers for Medicare & Medicaid Services
determined that no national coverage determination (NCD) is appropriate at
this time for FDG PET for Inflammation and Infection. In the absence of an
NCD, coverage determinations will be made by the Medicare Administrative
Contractors under section 1862(a)(1)(A) of the Social Security Act.
**100.14  Surgery for Diabetes (RETIRED)  
_(Rev. 11892; Issued: 03-09-23; Effective: 04-10-23; Implementation:
04-10-23)**

_

Please note section 100.14 has been removed from the NCD Manual and
incorporated into NCD 100.1 _effective September 24, 2013._
**B. Nationally Covered Indications

**

The confirmatory analyses were not published during the 24-month time period.
Therefore, effective December 15, 2017, CMS determines that there are no
nationally covered indications for PET NaF-18.

**C. Nationally Non-Covered Indications

**

Effective December 15, 2017, CMS determines that PET NaF-18 PET is nationally
non-covered.

**D. Other

**

Other PET radiopharmaceutical tracers for cancer can be covered at local
Medicare Administrative Contractor discretion when used according to their
FDA-approved indication(s).

(This NCD last reviewed December 2017.)
**B. Nationally Covered Indications**

Effective for claims with dates of service on or after August 25, 2010, CMS
will cover tobacco cessation counseling for outpatient and hospitalized
Medicare beneficiaries

  1. Who use tobacco, regardless of whether they have signs or symptoms of tobacco-related disease;
  2. Who are competent and alert at the time that counseling is provided; and,
  3. Whose counseling is furnished by a qualified physician or other Medicare-recognized practitioner.

Intermediate and intensive smoking cessation counseling services will be
covered under Medicare Part B when the above conditions of coverage are met,
subject to frequency and other limitations. That is, similar to existing
tobacco cessation counseling for symptomatic individuals, CMS will allow 2
individual tobacco cessation counseling attempts per 12-month period. Each
attempt may include a maximum of 4 intermediate OR intensive sessions, with a
total benefit covering up to 8 sessions per 12-month period per Medicare
beneficiary who uses tobacco. The practitioner and patient have the
flexibility to choose between intermediate (more than 3 minutes but less than
10 minutes), or intensive (more than 10 minutes) cessation counseling sessions
for each attempt.

**C. Nationally Non-Covered Indications**

Inpatient hospital stays with the principal diagnosis of tobacco use disorder
are not reasonable and necessary for the effective delivery of tobacco
cessation counseling services. Therefore, we will not cover tobacco cessation
services if tobacco cessation is the primary reason for the patients hospital
stay.

**D. Other**

Section 4104 of the Affordable Care Act provided for a waiver of the Medicare
coinsurance and Part B deductible requirements for this service effective on
or after January 1, 2011. Until that time, this service will continue to be
subject to the standard Medicare coinsurance and Part B deductible
requirements.

(This NCD last reviewed December 2016.)
**240.2.2 - Home Oxygen Use to Treat Cluster Headache (CH) (RETIRED)  
(Rev. 11892; Issued: 03-09-23; Effective: 04-10-23; Implementation:
04-10-23)**

Effective September 27, 2021, the Centers for Medicare & Medicaid Services
removed the national coverage determination (NCD) for home oxygen use to treat
cluster headaches. In the absence of an NCD, coverage determinations will be
made by the Medicare Administrative Contractors under section 1862(a)(1)(A) of
the Social Security Act, as allowed and described in Chapter 1, Section 240.2
(Home Use of Oxygen), Subsection D, of Publication 100-03 of the NCD Manual.
**B. Nationally Covered Indications**

Effective for claims with dates of service on or after October 14, 2011, CMS
will cover annual screening up to 15 minutes for Medicare beneficiaries when
staff-assisted depression care supports are in place to assure accurate
diagnosis, effective treatment, and follow-up. At a minimum level, staff-
assisted supports consist of clinical staff (e.g., nurse, physician assistant)
in the primary care setting who can advise the physician of screening results
and who can facilitate and coordinate referrals to mental health treatment.

**C. Nationally Non-Covered Indications**

Screening for depression is non-covered when performed more than one time in a
12-month period. In addition, self-help materials, telephone calls, and web-
based counseling are not separately reimbursable by Medicare and are not part
of this NCD.

**D. Other**

Medicare coinsurance and Part B deductible are waived for this preventive
service.

(This NCD last reviewed October 2011.)
**

B.      Nationally Covered Indications

**

Effective April 1, 2004, OPT with verteporfin continues to be approved for a
diagnosis of neovascular AMD with predominately classic subfoveal CNV lesions
(where the area of classic CNV occupies  50% of the area of the entire
lesion) at the initial visit as determined by an FA. (CNV lesions are
comprised of classic and/or occult components.) Subsequent follow-up visits
require either an optical coherence tomography (OCT) (effective April 3. 2013)
or an FA (effective April 1, 2004) to access treatment response. There are no
requirements regarding visual acuity, lesion size, and number of re-treatments
when treating predominantly classic lesions.

In addition, after thorough review and reconsideration of the August 20, 2002,
non-coverage policy, CMS determines that the evidence is adequate to conclude
that OPT with verteporfin is reasonable and necessary for treating:

  1. Subfoveal occult with no classic CNV associated with AMD; and, 
  2. Subfoveal minimally classic CNV (where the area of classic CNV occupies < 50% of the area of the entire lesion) associated with AMD. 

The above 2 indications are considered reasonable and necessary only when:

  1. The lesions are small (4 disk areas or less in size) at the time of initial treatment or within the 3 months prior to initial treatment; and, 
  2. The lesions have shown evidence of progression within the 3 months prior to initial treatment. Evidence of progression must be documented by deterioration of visual acuity (at least 5 letters on a standard eye examination chart), lesion growth (an increase in at least 1 disk area), or the appearance of blood associated with the lesion. 

**

C.      Nationally Non-Covered Indications

**

Other uses of OPT with verteporfin to treat AMD not already addressed by CMS
will continue to be non-covered. These include, but are not limited to, the
following AMD indications:

  * Juxtafoveal or extrafoveal CNV lesions (lesions outside the fovea),
  * Inability to obtain a fluorescein angiogram,
  * Atrophic or dry AMD.

**

D.      Other

**

The OPT with verteporfin for other ocular indications, such as pathologic
myopia or presumed ocular histoplasmosis syndrome, continue to be eligible for
local coverage determinations through individual Medicare Administrative
Contractor discretion.
**

B.      Nationally Covered Indications

**

Effective April 1, 2004, OPT with verteporfin is covered for patients with a
diagnosis of neovascular age-related macular degeneration (AMD) with:

  * Predominately classic subfoveal choroidal neovascularization (CNV) lesions (where the area of classic CNV occupies  50% of the area of the entire lesion) at the initial visit as determined by a fluorescein angiogram (FA). (CNV lesions are comprised of classic and/or occult components.) Subsequent follow-up visits require either an optical coherence tomography (effective April 3, 2013) or an FA (effective April 1, 2004) to access treatment response. 

There are no requirements regarding visual acuity, lesion size, and number of
retreatments when treating predominantly classic lesions.

  * Subfoveal occult with no classic CNV associated with AMD. 
  

  * Subfoveal minimally classic CNV (where the area of classic CNV occupies < 50% of the area of the entire lesion) associated with AMD. 

The above 2 indications are considered reasonable and necessary only when:

    1. The lesions are small (4 disk areas or less in size) at the time of initial treatment or within the 3 months prior to initial treatment; and, 
    2. The lesions have shown evidence of progression within the 3 months prior to initial treatment. Evidence of progression must be documented by deterioration of visual acuity (at least 5 letters on a standard eye examination chart), lesion growth (an increase in at least 1 disk area), or the appearance of blood associated with the lesion. 

**

C.      Nationally Non-Covered Indications

**

Other uses of OPT with verteporfin to treat AMD not already addressed by the
Centers for Medicare & Medicaid Services will continue to be non-covered.
These include, but are not limited to, the following AMD indications:
juxtafoveal or extrafoveal CNV lesions (lesions outside the fovea), inability
to obtain an FA, or atrophic or dry AMD.

**D.      Other**

The OPT with verteporfin for other ocular indications, such as pathologic
myopia or presumed ocular histoplasmosis syndrome, continue to be eligible for
local coverage determinations through individual Medicare Administrative
Contractor discretion.
**230.11 - Diagnostic Pap Smears (RETIRED)  
(Rev. 11892; Issued: 03-09-23; Effective: 04-10-23; Implementation:
04-10-23)**

The guide in [190.2](https://www.cms.gov/medicare-coverage-
database/details/ncd-details.aspx?NCDId=184) applies.
_**(Rev. 12364; Issued:11-16-23; Effective:10-13-23;
Implementation:12-19-23)**

Effective October 13, 2023, CMS removed NCD 220.6.20, ending CED for PET beta
amyloid imaging and permitting Medicare coverage determinations for PET beta
amyloid imaging to be made by the Medicare Administrative Contractors under
section 1862(a)(1)(A) of the Social Security Act_