TL;DR: The Centers for Medicare & Medicaid Services modified NCD 178 for Magnetic Resonance Angiography, effective March 7, 2026. The section has been retired — here's what that means for your billing workflow.
CMS Magnetic Resonance Angiography coverage policy under NCD 178 is officially retired. The NCD 178 Medicare designation for MRA has been folded into NCD 220.2, which governs Magnetic Resonance Imaging broadly. This happened back in 2010, but the March 2026 administrative update formalizes the retirement in the NCD Manual and closes the loop on a policy that's been a source of confusion for billing teams for years.
Quick-Reference Table
| Field | Detail |
|---|---|
| Payer | CMS |
| Policy | Magnetic Resonance Angiography — RETIRED |
| Policy Code | NCD 178 |
| Change Type | Modified (Retirement Formalized) |
| Effective Date | 2026-03-07 |
| Impact Level | Medium |
| Specialties Affected | Radiology, Cardiology, Vascular Surgery, Neurology, Outpatient Hospital Billing |
| Key Action | Stop referencing NCD 178 for MRA coverage determinations — redirect all MRA medical necessity reviews to NCD 220.2 |
CMS Magnetic Resonance Angiography Coverage Criteria and Medical Necessity Requirements 2026
Here's the honest summary: NCD 178 no longer contains active coverage criteria. It hasn't since June 3, 2010.
The Centers for Medicare & Medicaid Services merged section 220.3 — the standalone MRA section — into section 220.2 over 15 years ago. This March 2026 update makes the retirement explicit in the NCD Manual. If your team has been pulling coverage policy from NCD 178, you've been working from a dead reference.
For MRA medical necessity determinations, your operative document is now NCD 220.2 (Magnetic Resonance Imaging). That's where CMS sets the coverage criteria, the clinical indications, and the medical necessity standards that govern whether an MRA claim will pay or deny. Cross-references in the retired NCD 178 also point to NCD 220.2.1 for Magnetic Resonance Spectroscopy — a separate but related policy your team should know.
The retirement doesn't change what MRA procedures CMS covers. It changes where you look to confirm coverage. That distinction matters more than it sounds.
If your billing guidelines, payer policy manuals, or internal documentation still point to NCD 178 as a standalone authority, update them now. The effective date of March 7, 2026 makes this official. Any prior authorization workflows, coverage check processes, or denial appeal letters that cite NCD 178 as active policy need to be corrected.
Coverage Indications at a Glance
The policy data for NCD 178 does not list active clinical indications — the coverage policy has been retired and merged. The table below reflects the current state of this NCD for billing purposes.
| Indication | Status | Relevant Codes | Notes |
|---|---|---|---|
| Magnetic Resonance Angiography (all indications) | Retired — refer to NCD 220.2 | See NCD 220.2 | Section 220.3 merged into 220.2 effective June 3, 2010 |
| MRI coverage (all MRA-related) | Active under NCD 220.2 | See NCD 220.2 | Cross-reference: NCD 220.2 governs MRA reimbursement |
| Magnetic Resonance Spectroscopy | Active under NCD 220.2.1 | See NCD 220.2.1 | Separate NCD, distinct from MRA billing |
No codes are listed in the NCD 178 policy data. See NCD 220.2 for the applicable code set governing MRA billing.
CMS Magnetic Resonance Angiography Billing Guidelines and Action Items 2026
The retirement of NCD 178 is administrative, but it has real teeth for billing teams who haven't kept pace. Here's what to do.
| # | Action Item |
|---|---|
| 1 | Pull every internal document that references NCD 178 and update it before March 7, 2026. This includes charge capture guides, coder reference sheets, denial management workflows, and any payer policy summaries your team maintains. If NCD 178 appears as an active policy reference anywhere, it needs to point to NCD 220.2 instead. |
| 2 | Redirect all MRA medical necessity reviews to NCD 220.2 immediately. That's where the active coverage criteria live. Medical necessity determinations for MRA billing must align with NCD 220.2 standards — not anything in the retired NCD 178 section. |
| 3 | Audit recent denial appeal letters that cite NCD 178. If your team wrote appeal letters in the last 12-24 months citing NCD 178 as the governing coverage policy, those citations were technically pointing to a retired section. Future appeals should cite NCD 220.2. This won't reopen old denials, but it protects you going forward. |
| 4 | Review prior authorization workflows for MRA. If your prior authorization request templates or PA checklists reference NCD 178 as the coverage basis, update them. Payers reviewing prior auth requests expect citations to active policy. A stale NCD reference can create friction — or worse, a denial on procedural grounds. |
| 5 | Confirm your Medicare Administrative Contractor's local coverage determination for MRA. NCD 220.2 is the national floor, but your MAC may have a local coverage determination that adds criteria or restrictions on top of it. The NCD retirement doesn't change MAC-level LCD authority. Check your MAC's LCD library if you haven't recently. |
| 6 | Don't confuse the 2026 administrative update with a coverage change. Nothing about what CMS covers for MRA changed on March 7, 2026. The reimbursement rules haven't shifted. The change is purely about where the policy lives in the NCD Manual. That said, billing teams that treat administrative updates as "nothing happened" are the same ones who get caught citing dead policy in audits. |
| 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 Magnetic Resonance Angiography Under NCD 178
Covered CPT Codes (When Selection Criteria Are Met)
The NCD 178 policy data does not list specific CPT or HCPCS codes. No codes are provided in the retired section. For the applicable code set governing MRA billing and reimbursement under Medicare, refer directly to NCD 220.2.
Not Covered / Experimental Codes
No experimental or non-covered code designations appear in the NCD 178 policy data.
Key ICD-10-CM Diagnosis Codes
No ICD-10-CM codes are listed in the NCD 178 policy data. Applicable diagnosis codes for MRA medical necessity are governed by NCD 220.2.
The Real Issue with "Administrative" Policy Retirements
Billing teams get burned by updates like this more often than they should. The change looks low-stakes — a retired section, no new codes, no new criteria. So it gets filed and forgotten.
The problem shows up six months later when a coder pulls a reference document that still lists NCD 178 as active policy. Or when an appeal letter cites it and a reviewer flags the stale reference. Or when a new hire uses an outdated training document as their guide for MRA claim denial responses.
This is the same pattern we've seen with other NCD consolidations — CMS quietly folds one section into another, the old reference stays in internal documents, and billing teams carry the liability. The fix isn't complicated. It just requires actually doing it.
If your organization bills significant MRA volume across radiology, cardiology, neurology, or vascular surgery, loop in your compliance officer before March 7, 2026. Make sure the update hits every reference document, not just the ones your billing team uses day-to-day.
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