Medicare National Coverage Determinations Manual 
Crosswalk CIM to NCD Sections 
The column on the far right (column 3) is in CIM sequence. Column 1 shows the NDC 
Manual section.  Note that the sections in the NCD are in CPT category sequence and not 
in Medicare benefit category sequence.  
NCD Section  Title  CIM Section  
310.1  Routine Costs in Clinical Trails  CIM 30-1 
10.8.1  Stem Cell Transplantation  CIM 35.30.1 
100.7  Colonic Irrigation  CIM 35-1 
20.29  Hyperbaric Oxygen Therapy  CIM 35-10 
80.2  Photodynamic Therapy  CIM 35-100 
250.4  Treatment of Actinic Keratosis  CIM 35-101 
160.25  Multiple Electroconvulsive Therapy (MECT)  CIM 35-103 
260.5  Intestinal and Multivisceral Transplantation  CIM 35-104 
230.3  Sterilization  CIM 35-11 
140.4  Plastic Surgery to Correct "Moon Face"  CIM 35-12 
150.7  Prolotherapy; Joint Sclerotherapy, and  CIM 35-13 
Ligamentous Injections with Sclerosing Agents 
70.1  Consultations With a Beneficiarys Family and  CIM 35-14 
Associates 
240.7  Postural Drainage Procedures and Pulmonary  CIM 35-15 
Exercises 
80.11  Vitrectomy  CIM 35-16 
160.1  Induced Lesions of Nerve Tracts  CIM 35-17 
30.4  Electrosleep Therapy  CIM 35-18 
30.6  Intravenous Histamine Therapy  CIM 35-19  NCD Section  Title  CIM Section  
150.1  Manipulation  CIM 35-2 
160.2  Treatment of Motor Function Disorders with  CIM 35-20 
Electric Nerve Stimulation 
10.3  Inpatient Hospital Pain Rehabilitation Programs  CIM 35-21 
10.4  Outpatient Hospital Pain Rehabilitation Programs  CIM 35-21.1 
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 
130.6  Treatment of Drug Abuse (Chemical  CIM 35-22.2 
Dependency) 
130.5  Treatment of Alcoholism and Drug Abuse in a  CIM 35-22.3 
Freestanding Clinic 
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 
230.4  Diagnosis and Treatment of Impotence  CIM 35-24 
20.10  Cardiac Rehabilitation Programs  CIM 35-25 
40.5  Treatment of Obesity  CIM 35-26 
30.1  Biofeedback Therapy  CIM 35-27 
30.1.1  Biofeedback Therapy For The Treatment Of  CIM 35-27.1 
Urinary Incontinence 
50.5  Oxygen Treatment of Inner Ear/Carbon Therapy  CIM 35-29 
240.3  Heat Treatment, Including the Use of Diathermy  CIM 35-3 
and Ultra-Sound for Pulmonary Conditions 
110.8  Blood Platelet Transfusions  CIM 35-30  NCD Section  Title  CIM Section  
270.4  Treatment Of Decubitus Ulcers  CIM 35-31  
100.8  Intestinal By-Pass Surgery  CIM 35-33 
230.2  Uroflowmetric Evaluations  CIM 35-33 
20.23  Fabric Wrapping of Abdominal Aneurysms  CIM 35-34 
20.28  Therapeutic Embolization  CIM 35-35 
20. 01  Vertebral Artery Surgery  CIM 35-37 
20. 2  Extracranial-Intracranial (EC-IC) Arterial Bypass  CIM 35-37 
Surgery 
110.15  Ultrafiltration, Hemoperfusion and  CIM 35-38 
Hemofiltration 
80.6  Intraocular Photography  CIM 35-39 
50.8  Ultrasonic Surgery  CIM 35-4 
100.1  Gastric Bypass Surgery for Obesity  CIM 35-40 
150.5  Diathermy Treatment  CIM 35-41 
130.7  Withdrawal Treatments for Narcotic Addictions  CIM 35-42 
10.1  Use Of Visual Tests Prior To And General   CIM 35-44 
Anesthesia During Cataract Surgery 
20.25  Cardiac Catheterization Performed in Other Than  CIM 35-45 
a Hospital Setting 
160.3  Assessing Patients Suitability for Electrical Nerve  CIM 35-46 
Stimulation 
160.7.1  Assessing Patients Suitability for Electrical Nerve  CIM 35-46 
Stimulation Therapy 
140.2  Breast Reconstruction Following Mastectomy  CIM 35-47 
150.2  Osteogenic Stimulator  CIM 35-48 
160.11  Osteogenic Stimulation   CIM 35-48  NCD Section  Title  CIM Section  
110.1  Hyperthermia for Treatment of Cancer  CIM 35-49 
30.8  Cellular Therapy  CIM 35-5 
50.7  Cochleostomy with Neurovascular Transplant for  CIM 35-50 
Menieres Disease 
130.8  Hemodialysis for Treatment of Schizophrenia  CIM 35-51 
140.5  Laser Procedures  CIM 35-52 
260.1  Adult Liver Transplantation  CIM 35-53 
260.2  Pediatric Liver Transplantation  CIM 35-53.1 
80.7  Refractive Keratoplasty  CIM 35-54 
240.6  Transvenous (Catheter) Pulmonary Embolectomy  CIM 35-55 
150.8  Fluidized Therapy Dry Heat for Certain  CIM 35-56 
Musculoskeletal Disorders 
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 
20.3  Thoracic Duct Drainage (TDD) In Renal  CIM 35-58 
Transplants 
100.2  Endoscopy  CIM 35-59 
30.2  Thermogenic Therapy  CIM 35-6 
110.14  Apheresis  (Therapeutic Pheresis)  CIM 35-60 
140.3  Transsexual Surgery  CIM 35-61 
160.14  Invasive Intracranial Pressure Monitoring  CIM 35-62 
50.6  Tinnitus Masking  CIM 35-63 
20.21  Chelation Therapy for Treatment of  CIM 35-64 
Atherosclerosis NCD Section  Title  CIM Section  
Atherosclerosis 
100.6  Gastric Freezing  CIM 35-65 
250.1  Treatment of Psoriasis  CIM 35-66 
170.2  Melodic Intonation Therapy  CIM 35-67 
100.9  Implantation of Anti-Gastroesophageal Reflux  CIM 35-69 
Device 
20.18  Carotid Body Resection/Carotid Body  CIM 35-7 
Denervation 
40.3  Closed-Loop Blood Glucose Control Device  CIM 35-70 
(CBGCD) 
110.16  Nonselective (Random) Transfusions and Living  CIM 35-71 
Related Donor Specific Transfusions (DST) in 
Kidney Transplantation 
160.15  Electrotherapy for Treatment of Facial Nerve  CIM 35-72 
Palsy (Bells Palsy) 
100.10  Injection Sclerotherapy for Esophageal Variceal  CIM 35-73 
Bleeding   
20.20  External Counterpulsation (ECP) for Severe  CIM 35-74 
Angina 
20.11  Intraoperative Ventricular Mapping   CIM 35-75 
150.4  Neuromuscular Electrical Stimulator (NMES) in  CIM 35-77 
the Treatment of Disuse Atrophy 
160.12  Neuromuscular Electrical Stimulation (NMES) in  CIM 35-77 
the Treatment of Disuse Atrophy 
20.12  Diagnostic Endocardial Electrical Stimulation  CIM 35-78 
(Pacing)    
10.6  Anesthesia in Cardiac Pacemaker Surgery  CIM 35-79 
20.8.3  Anesthesia in Cardiac Pacemaker Surgery  CIM 35-79 
30.3  Acupuncture  CIM 35-8  NCD Section  Title  CIM Section  
230.1  Treatment of Kidney Stones  CIM 35-81 
260.3  Pancreas Transplants  CIM 35-82 
100.3  24-Hour Ambulatory Esophegeal pH Monitoring  CIM 35-83 
160.4  Steroetactic Cingulotomy as a Means of  CIM 35-84 
Psychosurgery 
20.4  Implantation of Automatic Defibrillators  CIM 35-85 
100.11  Gastric Balloon for Treatment of Obesity  CIM 35-86 
260.9  Heart Transplants  CIM 35-87 
110.4  Extracorporeal Photopheresis  CIM 35-88 
170.3  Speech Pathology Services for the Treatment of  CIM 35-89 
Dysphagia 
80.10  Phaco-Emulsification Procedure  (Cataract  CIM 35-9 
Extraction) 
20.5  Extracorporeal Immunoadsorption (ECI) Using  CIM 35-90 
Protein A Columns  
100.13  Laproscopic Cholecystectomy  CIM 35-91 
30.5  Transcendental Meditation  CIM 35-92 
240.1  Lung Volume Reduction Surgery (Reduction  CIM 35-93 
Pneumoplasty) 
20.6  Transmyocardial Revascularization (TMR)  CIM 35-94 
20.26  Partial Ventriculectomy  CIM 35-95 
230.9  Cryosurgery of Prostate  CIM 35-96 
160.16  Vertebral Axial Decompression (VAX-D)  CIM 35-97 
270.1  Electrostimulation in the Treatment of Wounds  CIM 35-98 
140.1  Abortion   CIM 35-99  NCD Section  Title  CIM Section  
160.17  L-Dopa   CIM 45-1 
30.7  Laetrile and Related Substances  CIM 45-10 
10.5  Autogenous Epidural Blood Graft  CIM 45-11 
270.5  Porcine Skin and Gradient Pressure Dressings  CIM 45-12 
70.3  Physicians Office Within an Institution   CIM 45-15 
Coverage of Services and Supplies Incident to a 
Physicians Services 
110.2  Certain Drugs Distributed by the National Cancer  CIM 45-16 
Institute 
160.20  Transfer Factor For Treatment of Multiple  CIM 45-17 
Sclerosis 
110.5  Granulocyte Transfusions  CIM 45-18 
10.2  Transcutaneous Electrical Nerve Stimulation  CIM 45-19 
(TENS) for Acute Post-Operative Pain 
20.22  Ethylenediamine-Tetra-Acetic (EDTA) Chelation  CIM 45-20 
Therapy for Treatment of Atherosclerosis 
110.6  Scalp Hypothermia During Chemotherapy to  CIM 45-21 
Prevent Hair Loss 
260.7  Lymphocyte Immune Globulin, Anti-Thymocyte  CIM 45-22 
Globulin (Equine) 
230.12  Dimethyl Sulfoxide (DMSO)    CIM 45-23 
110.3  Anti-Inhibitor Coagulant Complex (AICC)  CIM 45-24 
160.13  Supplies Used in the Delivery of Transcutaneous  CIM 45-25 
Electrical Nerve Stimulation (TENS) and 
Neuromuscular Electrical Stimulation (NMES) 
270.3  Platelet-Derived Wound Healing Formula  CIM 45-26 
110.7  Blood Transfusions  CIM 45-27 
110.9  Antigens Prepared for Sublingual Administration  CIM 45-28  NCD Section  Title  CIM Section  
110.10  Intravenous Iron Therapy  CIM 45-29 
40.4  Insulin Syringe  CIM 45-3 
80.3  Photosensitive Drugs  CIM 45-30 
250.3  Intravenous Immune Globulin For The Treatment  CIM 45-31 
Of Autoimmune Mucutaneous Blistering 
Diseases  
230.19  Levocarnitine for Use in the Treatment of  CIM 45-32 
Carnitine Deficiency in ESRD Patients 
150.6  Vitamin B12 Injections to Strengthen Tendons;  CIM 45-4 
Ligaments; etc; of the Foot 
80.1  Hydrophilic Contact Lens for Corneal Bandage  CIM 45-7 
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) 
20.8.1  Cardiac Pacemaker Evaluation Services  CIM 50-1 
20.8.1.1  Transtelephonic Monitoring of Cardiac  CIM 50-1 
Pacemakers 
230.6  Vabra Aspirator  CIM 50-10 
220.1  Computerized Tomography   CIM 50-12 
220.2  Magnetic Resonance Imaging  CIM 50-13  
220.3  Magnetic Resonance Angiography  CIM 50-14 
20.15  Electrocardiographic Services  CIM 50-15 
250.2  Hemorheograph  CIM 50-16 
190.4  Electron Microscope  CIM 50-18 
70.4  Pronouncement of Death  CIM 50-19 
110.13  Cytotoxic Food Tests  CIM 50-2  NCD Section  Title  CIM Section  
190.2  Diagnostic Pap Smears  CIM 50-20 
230.11  Diagnostic Pap Smears  CIM 50-20 
210.2  Screening Pap Smears and Pelvic Examinations  CIM 50-20.1 
for Early Detection of Cervical or Vaginal Cance 
220.4  Mammograms  CIM 50-21 
110.12  Challenge Ingestion Food Testing  CIM 50-22 
190.1  Histocompatibility Testing  CIM 50-23 
190.6  Hair Analysis  CIM 50-24 
100.4  Esophageal Manometry  CIM 50-25 
260.6  Dental Examination Prior to Kidney  CIM 50-26 
Transplantation 
220.7  Xenon Scan  CIM 50-27 
70.5  Hospital and Skilled Nursing Facility Admission  CIM 50-28 
Diagnostic Procedures 
190.3  Cytogenetic Studies  CIM 50-29 
20.13  HIS Bundle Study  CIM 50-3 
220.8  Nuclear Radiology Procedure  CIM 50-30 
160.10  Evoked Response Tests  CIM 50-31 
20.7  Percutaneous Transluminal Angioplasty (PTA)     CIM 50-32 
300.1  Obsolete or Unreliable Diagnostic Tests  CIM 50-34 
190.5  Sweat Test  CIM 50-35 
220.6  Positron Emission Tomography (PET) Scans  CIM 50-36 
20.17  Noninvasive Tests of Carotid Function  CIM 50-37 
80.8  Endothelial Cell Photography    CIM 50-38 
160.21  Telephone Transmission of EEGs  CIM 50-39  NCD Section  Title  CIM Section  
160.22  Ambulatory EEG Monitoring  CIM 50-39.1 
230.5  Gravlee Jet Washer  CIM 50-4 
160.5  Sterotaxic Depth Electrode Implantation  CIM 50-40 
190.7  Human Tumor Stem Cell Drug Sensitivity Assays CIM 50-41 
20.19  Ambulatory Blood Pressure Monitoring  CIM 50-42 
220.9  Digital Subtraction Angiography  CIM 50-43 
150.3  Bone (Mineral) Density Studies  CIM 50-44 
190.8  Lymphocyte Mitogen Response Assays  CIM 50-45 
30.9  Transillumination Light Scanning or  CIM 50-46 
Diaphanography 
20.27  Cardiointegram (CIG) as an Alternative to Stress  CIM 50-47 
Test or Thallium Stress Test    
220.10  Portable Hand-Held X-Ray Instrument  CIM 50-48 
80.9  Computer Enhanced Perimetry  CIM 50-49 
220.11  Thermography  CIM 50-5 
20.24  Displacement Cardiography  CIM 50-50 
100.5  Diagnostic Breath Analyses  CIM 50-51 
190.9  Serologic Testing for Acquired  CIM 50-52 
Immunodeficiency Syndrome (AIDS)  
110.11  Food Allergy Testing and Treatment  CIM 50-53 
20.16  Cardiac Output Monitoring By Electrical  CIM 50-54 
Bioimpedance 
210.1  Prostate Cancer Screening Tests  CIM 50-55 
190.11    Home Prothrombin Time INR Monitoring for  CIM 50-56 
Anticoagulation Management  NCD Section  Title  CIM Section  
160.23  Current Perception Threshold/Sensory Nerve  CIM 50-57.1 
Conduction Threshold Test (sNCT) 
220.12  Single Photon Emission Computed Tomograph   CIM 50-58 
(SPECT) 
220.13  Percutaneous Image-Guided Breast Biopsy  CIM 50-59 
20.14  Plethysmography  CIM 50-6 
220.5  Ultrasound Diagnostic Procedures  CIM 50-7 
70.2  Consultation Services Rendered By a Podiatrist in  CIM 50-8 
a Skilled Nursing Facility 
100.12  Gastrophotography  CIM 50-9 
230.7  Water Purification and Softening Systems Used  CIM 55-1 
in Conjunction with Home Dialysis 
230.13  Peridex CAPD Filter Set  CIM 55-2 
230.14  Ultrafiltration Monitor    CIM 55-3 
40.2  Home Blood Glucose Monitors  CIM 60-11 and CIM 
60-14 
 
280.14  Infusion Pumps  CIM 60-14 
280.5  Safety Roller  CIM 60-15 
280.6  Pneumatic Compression Devices  CIM 60-16 
240.4  Continuous Positive Airway Pressure (CPAP)  CIM 60-17 
280.7  Hospital Beds  CIM 60-18 
280.8  Air-Fluidized Bed  CIM 60-19 
280.13  Transcutaneous Electrical Nerve Stimulators  CIM 60-20 
(TENS) 
240.5  Intrapulmonary Percussive Ventilator (IPV)  CIM 60-21  NCD Section  Title  CIM Section  
160.18  Vagus Nerve Stimulation for Treatment of  CIM 60-22 
Seizures 
50.1  Speech Generating Devices  CIM 60-23 
230.8  Non-Implantable Pelvic Flood Electrical  CIM 60-24 
Stimulator 
270.2  Noncontact Normothermic Wound Therapy  CIM 60-25 
(NNWT) 
280.2  White Cane for Use by a Blind Person  CIM 60-3 
240.2  Home Use of Oxygen  CIM 60-4 
280.9  Power Operated Vehicles That May Be Used as  CIM 60-5 
Wheelchairs 
280.3  Specially Sized Wheelchairs  CIM 60-6 
20.8.2  Self-Contained Pacemaker Monitors  CIM 60-7 
280.4  Seat Lift  CIM 60-8 
280.1  Durable Medical Equipment Reference List  CIM 60-9 
80.5  Scleral Shell  CIM 65.3 
80.4  Hydrophilic Contact Lenses  CIM 65-1 
180.2  Enteral and Parenteral Nutritional Therapy  CIM 65-10 
230.16  Bladder Stimulators (Pacemakers)  CIM 65-11 
160.19  Phrenic Nerve Stimulator  CIM 65-13 
50.3  Cochlear Implantation  CIM 65-14 
20.9  Artificial Hearts and Related Devices  CIM 65-16 
50.4  Tracheostomy Speaking Valve  CIM 65-165 
230.17  Urinary Drainage Bags  CIM 65-17 
230.18  Sacral Nerve Stimulation for Urinary  CIM 65-18 
Incontinence NCD Section  Title  CIM Section  
Incontinence 
160.24  Deep Brain Stimulation for Essential Tremor and  CIM 65-19 
Parkinsons Disease 
230.15  Electrical Continence Aid  CIM 65-2 
160.6  Carotid Sinus Nerve Stimulator  CIM 65-4 
50.2  Electronic Speech Aids  CIM 65-5 
20.8  Cardiac Pacemakers  CIM 65-6 
80.12  Intraocular Lenses (IOLs)  CIM 65-7 
160.7  Electrical Nerve Stimulators  CIM 65-8 
230.10  Incontinence Control Devices  CIM 65-9 
280.11  Corset Used as Hernia Support  CIM 70-1 
280.12  Sykes Hernia Control  CIM 70-2 
280.10  Prosthetic Shoe  CIM 70-3 
170.1  Institutional and Home Care Patient Education  CIM 80-1 
Programs  
40.1  Diabetes Outpatient Self-Management Training  CIM 80-2 
180.1  Medical Nutrition Therapy  CIM 80-3 
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