---
kind: "section"
citation: "42 C.F.R. § 405.1060"
title: "42"
number: "405.1060"
heading: "Applicability of national coverage determinations (NCDs)."
url: "https://uscodex.org/cfr/42/405.1060"
---

# §405.1060. Applicability of national coverage determinations (NCDs).

- (a) **General rule.**
  - (1) An NCD is a determination by the Secretary of whether a particular item or service is covered nationally under Medicare.
  - (2) An NCD does not include a determination of what code, if any, is assigned to a particular item or service covered under Medicare or a determination of the amount of payment made for a particular item or service.
  - (3) NCDs are made under section 1862(a)(1) of the Act as well as under other applicable provisions of the Act.
  - (4) An NCD is binding on fiscal intermediaries, carriers, QIOs, QICs, ALJs and attorney adjudicators, and the Council.
- (b) **Review by an ALJ or attorney adjudicator.**
  - (1) An ALJ or attorney adjudicator may not disregard, set aside, or otherwise review an NCD.
  - (2) An ALJ or attorney adjudicator may review the facts of a particular case to determine whether an NCD applies to a specific claim for benefits and, if so, whether the NCD was applied correctly to the claim.
- (c) **Review by the Council.**
  - (1) The Council may not disregard, set aside, or otherwise review an NCD for purposes of a [section 1869](/cfr/42/1869.md) claim appeal, except that the DAB may review NCDs as provided under [part 426 of this title](/cfr/42/part426.md).
  - (2) The Council may review the facts of a particular case to determine whether an NCD applies to a specific claim for benefits and, if so, whether the NCD was applied correctly to the claim.

## Notes

### Amendments

[70 FR 11472, Mar. 8, 2005, as amended at 70 FR 37704, June 30, 2005; 82 FR 5121, Jan. 17, 2017]

### Source

Source: 70 FR 11472, Mar. 8, 2005, unless otherwise noted.

### Authority

Authority: 42 U.S.C. 263a, 405(a), 1302, 1320b-12, 1395x, 1395y(a), 1395ff, 1395hh, 1395kk, 1395rr, and 1395ww(k).

### Amendments

[70 FR 11472, Mar. 8, 2005, as amended at 70 FR 37704, June 30, 2005; 82 FR 5121, Jan. 17, 2017]