A national coverage determination (NCD) is a United States nationwide determination of whether Medicare will pay for an item or service. It is a form of utilization management and forms a medical guideline on treatment.
Medicare coverage is limited to items and services that are considered "reasonable and necessary" for the diagnosis or treatment of an illness or injury (and within the scope of a Medicare benefit category).
In the absence of a NCD, an item or service is covered at the discretion of the Medicare contractors based on a local coverage determination (LCD). As of 2015, local coverage determinations only become public on an appeal, and do not set a precedent.: 458
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