Medicare National Coverage Determinations Manual 
Crosswalk to CIM Sections 
Cross references are provided at detailed level only (e.g., at each of sections 10.1 through 
10.5) as opposed to Section 10. Note that the sections are in CPT category sequence and 
not in Medicare benefit category sequence. 
NCD Section  Title  CIM Section # 
10  Anesthesia and Pain Management  Header 
10.1  Use Of Visual Tests Prior To And General  CIM 35-44 
Anesthesia During Cataract Surgery 
10.2  Transcutaneous Electrical Nerve Stimulation  CIM 45-19 
(TENS) for Acute Post-Operative Pain 
10.3  Inpatient Hospital Pain Rehabilitation Programs  CIM 35-21 
10.4  Outpatient Hospital Pain Rehabilitation Programs  CIM 35-21.1 
10.5  Autogenous Epidural Blood Graft  CIM 45-11 
10.6  Anesthesia in Cardiac Pacemaker Surgery  CIM 35-79 
20  Cardiovascular System  Header 
20. 1  Vertebral Artery Surgery  CIM 35-37 
20. 2  Extracranial-Intracranial (EC-IC) Arterial Bypass  CIM 35-37 
Surgery 
20.3  Thoracic Duct Drainage (TDD) In Renal  CIM 35-58 
Transplants 
20.4  Implantation of Automatic Defibrillators  CIM 35-85 
20.5  Extracorporeal Immunoadsorption (ECI) Using  CIM 35-90 
Protein A Columns  
20.6  Transmyocardial Revascularization (TMR)  CIM 35-94 
20.7  Percutaneous Transluminal Angioplasty (PTA)     CIM 50-32 
20.8  Cardiac Pacemakers  CIM 65-6  NCD Section  Title  CIM Section # 
20.8.1  Cardiac Pacemaker Evaluation Services  CIM 50-1 
20.8.1.1  Transtelephonic Monitoring of Cardiac  CIM 50-1 
Pacemakers 
20.8.2  Self-Contained Pacemaker Monitors  CIM 60-7 
20.8.3  Anesthesia in Cardiac Pacemaker Surgery  CIM 35-79 
20.9  Artificial Hearts and Related Devices  CIM 65-16 
20.10  Cardiac Rehabilitation Programs  CIM 35-25 
20.11  Intraoperative Ventricular Mapping   CIM 35-75 
20.12  Diagnostic Endocardial Electrical Stimulation  CIM 35-78 
(Pacing)    
20.13  HIS Bundle Study  CIM 50-3 
20.14  Plethysmography  CIM 50-6 
20.15  Electrocardiographic Services  CIM 50-15 
20.16  Cardiac Output Monitoring By Electrical  CIM 50-54 
Bioimpedance 
20.17  Noninvasive Tests of Carotid Function  CIM 50-37 
20.18  Carotid Body Resection/Carotid Body  CIM 35-7 
Denervation 
20.19  Ambulatory Blood Pressure Monitoring  CIM 50-42 
20.20  External Counterpulsation (ECP) for Severe  CIM 35-74 
Angina 
20.21  Chelation Therapy for Treatment of  CIM 35-64 
Atherosclerosis 
20.22  Ethylenediamine-Tetra-Acetic (EDTA) Chelation  CIM 45-20 
Therapy for Treatment of Atherosclerosis 
20.23  Fabric Wrapping of Abdominal Aneurysms  CIM 35-34  NCD Section  Title  CIM Section # 
20.24  Displacement Cardiography  CIM 50-50 
20.25  Cardiac Catheterization Performed in Other Than  CIM 35-45 
a Hospital Setting 
20.26  Partial Ventriculectomy  CIM 35-95 
20.27  Cardiointegram (CIG) as an Alternative to Stress  CIM 50-47 
Test or Thallium Stress Test    
20.28  Therapeutic Embolization  CIM 35-35 
20.29  Hyperbaric Oxygen Therapy  CIM 35-10 
30  Complementary and Alternative Medicine  Header 
30.1  Biofeedback Therapy  CIM 35-27 
30.1.1  Biofeedback Therapy For The Treatment Of  CIM 35-27.1 
Urinary Incontinence 
30.2  Thermogenic Therapy  CIM 35-6 
30.3  Acupuncture  CIM 35-8 
30.4  Electrosleep Therapy  CIM 35-18 
30.5  Transcendental Meditation  CIM 35-92 
30.6  Intravenous Histamine Therapy  CIM 35-19 
30.7  Laetrile and Related Substances  CIM 45-10 
30.8  Cellular Therapy  CIM 35-5 
30.9  Transillumination Light Scanning or  CIM 50-46 
Diaphanography 
40  Endocrine System and Metabolism  Header 
40.1  Diabetes Outpatient Self-Management Training  CIM 80-2 
40.2  Home Blood Glucose Monitors  CIM 60-11 and CIM 
60-14  NCD Section  Title  CIM Section # 
40.3  Closed-Loop Blood Glucose Control Device  CIM 35-70 
(CBGCD) 
40.4  Insulin Syringe  CIM 45-3 
40.5  Treatment of Obesity  CIM 35-26 
50  Ear, Nose and Throat (ENT)  Header  
50.1  Speech Generating Devices  CIM 60-23 
50.2  Electronic Speech Aids  CIM 65-5 
50.3  Cochlear Implantation  CIM 65-14 
50.4  Tracheostomy Speaking Valve  CIM 65-165 
50.5  Oxygen Treatment of Inner Ear/Carbon Therapy  CIM 35-29 
50.6  Tinnitus Masking  CIM 35-63 
50.7  Cochleostomy with Neurovascular Transplant for  CIM 35-50 
Menieres Disease 
50.8  Ultrasonic Surgery  CIM 35-4 
60  Emergency Medicine  Reserved - no text 
70  Evaluation and Management of Patients  Header 
(office/hospital/home) 
70.1  Consultations With a Beneficiarys Family and  CIM 35-14 
Associates 
70.2  Consultation Services Rendered By a Podiatrist  CIM 50-8 
in a Skilled Nursing Facility 
70.2.1  Services Provided for the Diagnosis and  CIM 50.8.1 
Treatment of Diabetic Sensory Neuropathy with 
Loss of Protective Sensation (aka Diabetic 
Peripheral Neuropathy) 
70.3  Physicians Office Within an Institution   CIM 45-15 
Coverage of Services and Supplies Incident to a 
Physicians Services  NCD Section  Title  CIM Section # 
70.4  Pronouncement of Death  CIM 50-19 
70.5  Hospital and Skilled Nursing Facility Admission  CIM 50-28 
Diagnostic Procedures 
80  Eye  Header 
80.1  Hydrophilic Contact Lens for Corneal Bandage  CIM 45-7 
80.2  Photodynamic Therapy  CIM 35-100 
80.3  Photosensitive Drugs  CIM 45-30 
80.4  Hydrophilic Contact Lenses  CIM 65-1 
80.5  Scleral Shell  CIM 65.3 
80.6  Intraocular Photography  CIM 35-39 
80.7  Refractive Keratoplasty  CIM 35-54 
80.8  Endothelial Cell Photography    CIM 50-38 
80.9  Computer Enhanced Perimetry  CIM 50-49 
80.10  Phaco-Emulsification Procedure  (Cataract  CIM 35-9 
Extraction) 
80.11  Vitrectomy  CIM 35-16 
80.12  Intraocular Lenses (IOLs)  CIM 65-7 
90  Genetics  Reserved - no text 
100  Gastrointestinal System  Header 
100.1  Gastric Bypass Surgery for Obesity  CIM 35-40 
100.2  Endoscopy  CIM 35-59 
100.3  24-Hour Ambulatory Esophegeal pH Monitoring  CIM 35-83 
100.4  Esophageal Manometry  CIM 50-25 
100.5  Diagnostic Breath Analyses  CIM 50-51  NCD Section  Title  CIM Section # 
100.6  Gastric Freezing  CIM 35-65 
100.7  Colonic Irrigation  CIM 35-1 
100.8  Intestinal By-Pass Surgery  CIM 35-33 
100.9  Implantation of Anti-Gastroesophageal Reflux  CIM 35-69 
Device 
100.10  Injection Sclerotherapy for Esophageal Variceal  CIM 35-73 
Bleeding   
100.11  Gastric Balloon for Treatment of Obesity  CIM 35-86 
100.12  Gastrophotography  CIM 50-9 
100.13  Laproscopic Cholecystectomy  CIM 35-91 
110  Hematology/Immunology/Oncology  Header 
110.1  Hyperthermia for Treatment of Cancer  CIM 35-49 
110.2  Certain Drugs Distributed by the National Cancer  CIM 45-16 
Institute 
110.3  Anti-Inhibitor Coagulant Complex (AICC)  CIM 45-24 
110.4  Extracorporeal Photopheresis  CIM 35-88 
110.5  Granulocyte Transfusions  CIM 45-18 
110.6  Scalp Hypothermia During Chemotherapy to  CIM 45-21 
Prevent Hair Loss 
110.7  Blood Transfusions  CIM 45-27 
110.8  Blood Platelet Transfusions  CIM 35-30 
10.8.1  Stem Cell Transplantation  CIM 35.30.1 
110.9  Antigens Prepared for Sublingual Administration  CIM 45-28 
110.10  Intravenous Iron Therapy  CIM 45-29 
110.11  Food Allergy Testing and Treatment  CIM 50-53  NCD Section  Title  CIM Section # 
110.12  Challenge Ingestion Food Testing  CIM 50-22 
110.13  Cytotoxic Food Tests  CIM 50-2 
110.14  Apheresis  (Therapeutic Pheresis)  CIM 35-60 
110.15  Ultrafiltration, Hemoperfusion and  CIM 35-38 
Hemofiltration 
110.16  Nonselective (Random) Transfusions and Living  CIM 35-71 
Related Donor Specific Transfusions (DST) in 
Kidney Transplantation 
120  Infectious Diseases  Reserved - no text 
130  Mental Health  Header 
130.1  Inpatient Hospital Stays for the Treatment of  CIM 35-22 
Alcoholism 
130.2  Outpatient Hospital Services for Treatment of  CIM 35-22 
Alcoholism 
130.3  Chemical Aversion Therapy for Treatment of  CIM 35-23 
Alcoholism 
130.4  Electrical Aversion Therapy for Treatment of  CIM 35-23.1 
Alcoholism 
130.5  Treatment of Alcoholism and Drug Abuse in a  CIM 35-22.3 
Freestanding Clinic 
130.6  Treatment of Drug Abuse (Chemical  CIM 35-22.2 
Dependency) 
130.7  Withdrawal Treatments for Narcotic Addictions  CIM 35-42 
130.8  Hemodialysis for Treatment of Schizophrenia  CIM 35-51 
140  Miscellaneous Surgical Procedures  Header 
140.1  Abortion   CIM 35-99 
140.2  Breast Reconstruction Following Mastectomy  CIM 35-47  NCD Section  Title  CIM Section # 
140.3  Transsexual Surgery  CIM 35-61 
140.4  Plastic Surgery to Correct "Moon Face"  CIM 35-12 
140.5  Laser Procedures  CIM 35-52 
150  Musculoskeletal  System  Header 
150.1  Manipulation  CIM 35-2 
150.2  Osteogenic Stimulator  CIM 35-48 
150.3  Bone (Mineral) Density Studies  CIM 50-44 
150.4  Neuromuscular Electrical Stimulator (NMES) in  CIM 35-77 
the Treatment of Disuse Atrophy 
150.5  Diathermy Treatment  CIM 35-41 
150.6  Vitamin B12 Injections to Strengthen Tendons;  CIM 45-4 
Ligaments; etc; of the Foot 
150.7  Prolotherapy; Joint Sclerotherapy, and  CIM 35-13 
Ligamentous Injections with Sclerosing Agents 
150.8  Fluidized Therapy Dry Heat for Certain  CIM 35-56 
Musculoskeletal Disorders 
160  Nervous System  Header 
160.1  Induced Lesions of Nerve Tracts  CIM 35-17 
160.2  Treatment of Motor Function Disorders with  CIM 35-20 
Electric Nerve Stimulation 
160.3  Assessing Patients Suitability for Electrical Nerve  CIM 35-46 
Stimulation 
160.4  Steroetactic Cingulotomy as a Means of  CIM 35-84 
Psychosurgery 
160.5  Sterotaxic Depth Electrode Implantation  CIM 50-40 
160.6  Carotid Sinus Nerve Stimulator  CIM 65-4  NCD Section  Title  CIM Section # 
160.7  Electrical Nerve Stimulators  CIM 65-8 
160.7.1  Assessing Patients Suitability for Electrical Nerve  CIM 35-46 
Stimulation Therapy 
160.8  Electroencephalographic Monitoring During  CIM 35-57 
Surgical Procedures Involving the Cerebral 
Vasculature 
160.9  Electroencephalographic (EEG) Monitoring  CIM 35-57.1 
During Open-Heart Surgery 
160.10  Evoked Response Tests  CIM 50-31 
160.11  Osteogenic Stimulation   CIM 35-48 
160.12  Neuromuscular Electrical Stimulation (NMES) in  CIM 35-77 
the Treatment of Disuse Atrophy 
160.13  Supplies Used in the Delivery of Transcutaneous  CIM 45-25 
Electrical Nerve Stimulation (TENS) and 
Neuromuscular Electrical Stimulation (NMES) 
160.14  Invasive Intracranial Pressure Monitoring  CIM 35-62 
160.15  Electrotherapy for Treatment of Facial Nerve  CIM 35-72 
Palsy (Bells Palsy) 
160.16  Vertebral Axial Decompression (VAX-D)  CIM 35-97 
160.17  L-Dopa   CIM 45-1 
160.18  Vagus Nerve Stimulation for Treatment of  CIM 60-22 
Seizures 
160.19  Phrenic Nerve Stimulator  CIM 65-13 
160.20  Transfer Factor For Treatment of Multiple  CIM 45-17 
Sclerosis 
160.21  Telephone Transmission of EEGs  CIM 50-39 
160.22  Ambulatory EEG Monitoring  CIM 50-39.1 
160.23  Current Perception Threshold/Sensory Nerve  CIM - 50-57.1 
Cond ctionThresholdTest (sNCT) NCD Section  Title  CIM Section # 
Conduction Threshold Test (sNCT) 
160.24  Deep Brain Stimulation for Essential Tremor and  CIM 65-19 
Parkinsons Disease 
160.25  Multiple Electroconvulsive Therapy (MECT)  CIM 35-103 
170  Nonphysician Practitioner Services  Header 
(PT/OT/SLP/Audiologists/CRNA 
170.1  Institutional and Home Care Patient Education  CIM 80-1 
Programs  
170.2  Melodic Intonation Therapy  CIM 35-67 
170.3  Speech Pathology Services for the Treatment of  CIM 35-89 
Dysphagia 
180  Nutrition  Header 
180.1  Medical Nutrition Therapy  CIM 80-3 
180.2  Enteral and Parenteral Nutritional Therapy  CIM 65-10 
190  Pathology and Laboratory  Header 
190.1  Histocompatibility Testing  CIM 50-23 
190.2  Diagnostic Pap Smears  CIM 50-20 
190.3  Cytogenetic Studies  CIM 50-29 
190.4  Electron Microscope  CIM 50-18 
190.5  Sweat Test  CIM 50-35 
190.6  Hair Analysis  CIM 50-24 
190.7  Human Tumor Stem Cell Drug Sensitivity  CIM 50-41 
Assays 
190.8  Lymphocyte Mitogen Response Assays  CIM 50-45 
190.9  Serologic Testing for Acquired  CIM 50-52 
Immunodeficiency Syndrome (AIDS)   NCD Section  Title  CIM Section # 
190.10  Laboratory Tests  CRD Patients 
190.11    Home Prothrombin Time INR Monitoring for  CIM 50-56 
Anticoagulation Management 
200  Pharmacology  Reserved-no text 
210  Prevention  Header 
210.1  Prostate Cancer Screening Tests  CIM 50-55 
210.2  Screening Pap Smears and Pelvic Examinations  CIM 50-20.1 
for Early Detection of Cervical or Vaginal Cance 
220  Radiology  Header 
220.1  Computerized Tomography   CIM 50-12 
220.2  Magnetic Resonance Imaging  CIM 50-13  
220.3  Magnetic Resonance Angiography  CIM 50-14 
220.4  Mammograms  CIM 50-21 
220.5  Ultrasound Diagnostic Procedures  CIM 50-7 
220.6  Positron Emission Tomography (PET) Scans  CIM 50-36 
220.7  Xenon Scan  CIM 50-27 
220.8  Nuclear Radiology Procedure  CIM 50-30 
220.9  Digital Subtraction Angiography  CIM 50-43 
220.10  Portable Hand-Held X-Ray Instrument  CIM 50-48 
220.11  Thermography  CIM 50-5 
220.12  Single Photon Emission Computed Tomograph   CIM 50-58 
(SPECT) 
220.13  Percutaneous Image-Guided Breast Biopsy  CIM 50-59 
230  Renal and Genitourinary System, ESRD Services  Header 
230.1  Treatment of Kidney Stones  CIM 35-81  NCD Section  Title  CIM Section # 
230.2  Uroflowmetric Evaluations  CIM 35-33 
230.3  Sterilization  CIM 35-11 
230.4  Diagnosis and Treatment of Impotence  CIM 35-24 
230.5  Gravlee Jet Washer  CIM 50-4 
230.6  Vabra Aspirator  CIM 50-10 
230.7  Water Purification and Softening Systems Used  CIM 55-1 
in Conjunction with Home Dialysis 
230.8  Non-Implantable Pelvic Flood Electrical  CIM 60-24 
Stimulator 
230.9  Cryosurgery of Prostate  CIM 35-96 
230.10  Incontinence Control Devices  CIM 65-9 
230.11  Diagnostic Pap Smears  CIM 50-20 
230.12  Dimethyl Sulfoxide (DMSO)    CIM 45-23 
230.13  Peridex CAPD Filter Set  CIM 55-2 
230.14  Ultrafiltration Monitor    CIM 55-3 
230.15  Electrical Continence Aid  CIM 65-2 
230.16  Bladder Stimulators (Pacemakers)  CIM 65-11 
230.17  Urinary Drainage Bags  CIM 65-17 
230.18  Sacral Nerve Stimulation for Urinary  CIM 65-18 
Incontinence 
230.19  Levocarnitine for Use in the Treatment of  CIM 45-32 
Carnitine Deficiency in ESRD Patients 
240  Respiratory System  Header 
240.1  Lung Volume Reduction Surgery (Reduction  CIM 35-93 
Pneumoplasty)  NCD Section  Title  CIM Section # 
240.2  Home Use of Oxygen  CIM 60-4 
240.3  Heat Treatment, Including the Use of Diathermy  CIM 35-3 
and Ultra-Sound for Pulmonary Conditions 
240.4  Continuous Positive Airway Pressure (CPAP)  CIM 60-17 
240.5  Intrapulmonary Percussive Ventilator (IPV)  CIM 60-21 
240.6  Transvenous (Catheter) Pulmonary Embolectomy  CIM 35-55 
240.7  Postural Drainage Procedures and Pulmonary  CIM 35-15 
Exercises 
250  Skin  Header 
250.1  Treatment of Psoriasis  CIM 35-66 
250.2  Hemorheograph  CIM 50-16 
250.3  Intravenous Immune Globulin For The Treatment  CIM 45-31 
Of Autoimmune Mucutaneous Blistering 
Diseases  
250.4  Treatment of Actinic Keratosis  CIM 25-101 
260  Transplantation - Solid Organ Transplants, Stem  Header 
Cell Transplantation 
260.1  Adult Liver Transplantation  CIM 35-53 
260.2  Pediatric Liver Transplantation  CIM 35-53.1 
260.3  Pancreas Transplants  CIM 35-82 
260.4  Lung Transplantation  To be added 
260.5  Intestinal and Multivisceral Transplantation  CIM 35-104 
260.6  Dental Examination Prior to Kidney  CIM 50-26 
Transplantation 
260.7  Lymphocyte Immune Globulin, Anti-Thymocyte  CIM 45-22 
Globulin (Equine)  NCD Section  Title  CIM Section # 
260.8  Reserved   
260.9  Heart Transplants  CIM 35-87 
270  Wound Treatment  Header 
270.1  Electrostimulation in the Treatment of Wounds  CIM 35-98 
270.2  Noncontact Normothermic Wound Therapy  CIM 60-25 
(NNWT) 
270.3  Platelet-Derived Wound Healing Formula  CIM 45-26 
270.4  Treatment Of Decubitus Ulcers  CIM 35-31  
270.5  Porcine Skin and Gradient Pressure Dressings  CIM 45-12 
280  Medical and Surgical Supplies   Header 
280.1  Durable Medical Equipment Reference List  CIM 60-9 
280.2  White Cane for Use by a Blind Person  CIM 60-3 
280.3  Specially Sized Wheelchairs  CIM 60-6 
280.4  Seat Lift  CIM 60-8 
280.5  Safety Roller  CIM 60-15 
280.6  Pneumatic Compression Devices  CIM 60-16 
280.7  Hospital Beds  CIM 60-18 
280.8  Air-Fluidized Bed  CIM 60-19 
280.9  Power Operated Vehicles That May Be Used as  CIM 60-5 
Wheelchairs 
280.10  Prosthetic Shoe  CIM 70-3 
280.11  Corset Used as Hernia Support  CIM 70-1 
280.12  Sykes Hernia Control  CIM 70-2 
280.13  Transcutaneous Electrical Nerve Stimulators  CIM 60-20 
(TENS)  NCD Section  Title  CIM Section # 
280.14  Infusion Pumps  CIM 60-14 
290  Nursing Services  Header 
290.1  Home Health Visits to a Blind Diabetic  CIM 90-1 
290.2  Home Health Nurses' Visits to Patients Requiring  CIM 90-2 
Heparin Injections 
300  Diagnostic Tests Not Otherwise Classified  Header 
300.1  Obsolete or Unreliable Diagnostic Tests  CIM 50-34 
310   Clinical Trials  Header 
310.1  Routine Costs in Clinical Trails  CIM 30-1