Question

If an NCD does not exist for a particular service/procedure performed on a Medicare patient, who determines coverage?

a. The patient's primary care physician
b. The Centers for Medicare and Medicaid Services (CMS)
c. The hospital where the procedure is performed
d. The patient's insurance company

Answer 1

If an NCD does not exist for a particular service/procedure performed on a Medicare patient, the coverage is determined by the patient's insurance company.

Step-by-step explanation:

If an NCD (National Coverage Determination) does not exist for a particular service/procedure performed on a Medicare patient, the coverage is determined by d. The patient's insurance company.

Medicare is a health insurance program provided by the federal government for individuals aged 65 and older, as well as some younger individuals with disabilities. Medicare coverage decisions are made by the patient's insurance company, which may have specific policies and guidelines for determining coverage for a particular service or procedure.

It is important for Medicare patients to review their insurance policy and contact their insurance company for information regarding coverage of a specific service/procedure.