TL;DR: The Centers for Medicare & Medicaid Services modified NCD 111, the gastric balloon for treatment of obesity coverage policy, effective March 7, 2026. The standalone NCD 111 section has been retired and fully absorbed into NCD 100.1. If your billing team still references NCD 111 as a separate policy, you need to update your documentation and internal references now.
| Field | Detail |
|---|---|
| Payer | CMS |
| Policy | Gastric Balloon for Treatment of Obesity — RETIRED |
| Policy Code | NCD 111 |
| Change Type | Modified (Retirement / Consolidation) |
| Effective Date | 2026-03-07 |
| Impact Level | Low — but high risk for billing teams still routing claims against the retired section |
| Specialties Affected | Bariatric surgery, general surgery, obesity medicine, gastroenterology |
| Key Action | Remove NCD 111 from any internal policy libraries and route all gastric balloon billing references to NCD 100.1 |
CMS Gastric Balloon Coverage Policy Under NCD 111: What the 2026 Retirement Means
NCD 111 governed the CMS gastric balloon coverage policy for the treatment of obesity. Section 100.11 — which is what NCD 111 actually referenced — was removed from the National Coverage Determination Manual in 2013. The Centers for Medicare & Medicaid Services folded that content into NCD 100.1, effective September 24, 2013.
That's not a typo. The underlying consolidation happened over a decade ago. The March 7, 2026, effective date marks the formal retirement of NCD 111 as a standalone entry in CMS's policy system, closing out the last administrative reference to the old section.
So why does this matter now? Because billing teams and policy libraries that still cite NCD 111 as an active, separate policy are working from stale documentation. That creates real exposure — not because coverage changed, but because your internal references are pointing to a dead end.
CMS Gastric Balloon Coverage Criteria and Medical Necessity Requirements 2026
The short version: CMS gastric balloon medical necessity criteria do not live in NCD 111 anymore. They live in NCD 100.1. That's where you need to look if you're evaluating whether a gastric balloon procedure qualifies for Medicare reimbursement.
Section 100.11 of the NCD Manual was the controlling text for gastric balloon coverage policy under the old structure. CMS pulled it from the manual and merged it into the broader obesity treatment framework under NCD 100.1 back in 2013. The 2026 retirement of NCD 111 as a standalone policy code is an administrative cleanup — but it's one that billing teams need to act on.
From a medical necessity standpoint, your documentation and coverage determinations for gastric balloon billing should now reference NCD 100.1 exclusively. If your charge capture workflow or payer contract references still cite NCD 111, those references are invalid. A claim denial tied to a citation of a retired policy is an avoidable problem.
Prior authorization requirements, coverage limitations, and reimbursement criteria for gastric balloon procedures under Medicare are all governed by NCD 100.1 going forward. Check that policy directly for current medical necessity thresholds, because NCD 111 in the NCD 111 CMS system no longer contains operative coverage guidance.
Coverage Indications at a Glance
The policy data for NCD 111 does not include active indication-level coverage criteria. That content was migrated to NCD 100.1 in 2013. The table below reflects the current status of NCD 111 as a standalone policy.
| Indication | Status | Relevant Codes | Notes |
|---|---|---|---|
| Gastric balloon for treatment of obesity | Governed by NCD 100.1 | No codes listed under NCD 111 | Section 100.11 removed from NCD Manual effective 09-24-2013; all coverage guidance now under NCD 100.1 |
| NCD 111 standalone policy reference | Retired | N/A | Do not cite NCD 111 in billing documentation; reference NCD 100.1 |
CMS Gastric Balloon Billing Guidelines and Action Items 2026
The retirement of NCD 111 in the NCD 111 CMS system is administrative, but the downstream billing risk is real. Here's what to do before your next claim touches this procedure.
| # | Action Item |
|---|---|
| 1 | Remove NCD 111 from your internal policy library. If you maintain a reference library of active CMS NCDs for your billing team, pull NCD 111 out now. Replace it with a direct link to NCD 100.1. Leaving NCD 111 in place as an active reference invites misdocumentation. |
| 2 | Update any charge capture templates that reference NCD 111. Search your billing software and charge capture workflows for references to "NCD 111" or "section 100.11." Any hard-coded reference to the retired section should be updated to NCD 100.1. |
| 3 | Audit open claims tied to gastric balloon billing. If you have claims in progress that reference NCD 111 as a policy basis, review them before submission. A claim denial based on a retired policy citation is correctable — but it's cleaner to catch it before it goes out. |
| 4 | Confirm your prior authorization workflow points to NCD 100.1. If your team submits prior authorization requests for gastric balloon procedures, confirm the supporting documentation cites current policy. CMS reviewers and Medicare Administrative Contractors follow the live NCD Manual — and NCD 111 is no longer in it. |
| 5 | Educate your billing team on the consolidation history. Some staff may not know that NCD 111 and NCD 100.1 cover the same ground now. A short internal note explaining that the content migrated in 2013, and that the 2026 effective date is the formal close of the old policy code, prevents confusion on future claims. |
| 6 | Loop in your compliance officer if your documentation practices are unclear. If you're not sure how your organization has been citing this policy — or whether any historical claims are affected — talk to your compliance officer before March 7, 2026. The change is low-complexity, but compliance documentation around policy references can matter in an audit. |
| Previous Version | Current Version |
|---|---|
| Coverage is considered experimental and investigational for all indications | Coverage is considered medically necessary when specific criteria are met |
| Prior authorization is not required | Prior authorization is required for initial treatment |
| Documentation must include clinical history | Documentation must include clinical history |
| Re-review every 24 months | Re-review every 12 months with updated clinical documentation |
CPT, HCPCS, and ICD-10 Codes for Gastric Balloon Under NCD 111
The policy data for NCD 111 does not list specific CPT, HCPCS, or ICD-10 codes. This is consistent with the retirement status of the policy — the codes applicable to gastric balloon billing are now documented under NCD 100.1.
No Codes Listed Under NCD 111
| Code | Type | Description |
|---|---|---|
| — | — | No codes are listed in NCD 111. Refer to NCD 100.1 for applicable procedure and diagnosis codes governing gastric balloon reimbursement under Medicare. |
For gastric balloon billing guidelines and the current code set, go directly to NCD 100.1 in the CMS NCD Manual. The billing guidelines and covered indications — including any applicable HCPCS codes for the intragastric balloon device and associated procedure codes — are maintained there.
If you're unsure which codes map to gastric balloon procedures under NCD 100.1, check with your Medicare Administrative Contractor. Local coverage determination policies from your MAC may also apply and can layer additional requirements on top of the NCD.
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