National Coverage Determinations

Throughout the year, the Centers for Medicare & Medicaid Services (CMS) may issue notifications of new coverage rules for additional services covered by the Medicare program or clarifications of existing covered services. These notifications are called National Coverage Determinations (NCDs). NCDs expand coverage for a specific service or set of services to Medicare beneficiaries. Services addressed by NCDs may be covered by PrimeTime Health Plan. The CMS requires PrimeTime Health Plan to notify members when NCDs are issued.

What does this mean to me?

This is an announcement of new coverage rules. The new rules may not affect all members. See below for a list of NCDs for the current plan year.

What are the new coverage rules?

Medicare covers leadless pacemakers through Coverage with Evidence Development (CED) when procedures are performed in CMS-approved CED studies effective January 18, 2017.

NCD for Screening for Leadless Pacemakers_released 07.28.2017

Medicare has concluded that implanted permanent cardiac pacemakers, single chamber or dual chamber, are reasonable and necessary for the treatment of non-reversible symptomatic bradycardia due to sinus node dysfunction and second and/or third degree atrioventricular block.

NCD for Single Chamber and Dual Chamber Permanent Cardiac pacemakers_update released 10.26.2015

Medicare will cover a lung cancer screening with Low Dose Computed Tomography (LDCT) once per year for Medicare beneficiaries who meet specific criteria.

NCD for Lung Cancer Screening with Low Dose Computed Tomography (LDCT)_released 02.05.2015

What should I do if I have questions?

If you would like help understanding these new rules, call PrimeTime Health Plan at (330) 363-7407 or 1-800-577-5084. (TTY only call (330) 363-7460 or 1-800-617-7446.) We are available for phone calls Monday through Friday 8:00 a.m. to 8:00 p.m. From October 1st - February 14th the Service Center is open 7 days a week from 8:00 a.m. to 8:00 p.m.

PrimeTime Health Plan is an HMO-POS plan with a Medicare contract. Enrollment in PrimeTime Health Plan depends on contract renewal.

Last updated: 8/25/2017