TL;DR: The Centers for Medicare & Medicaid Services modified NCD 178, the Medicare Magnetic Resonance Angiography coverage policy, effective March 7, 2026. The section has been retired and merged into NCD 220.2. Here's what billing teams need to know.
If your team has been billing MRA claims under NCD 178 (policy section 220.3), that reference is now officially dead. The Centers for Medicare & Medicaid Services retired section 220.3 of the NCD Manual years ago — it merged into section 220.2 back in June 2010 — but this 2026 modification makes the retirement formal and final. No specific CPT or HCPCS codes are listed under NCD 178 v3, because the policy itself no longer carries independent coverage criteria. Everything lives under NCD 220.2 now.
Quick-Reference Table
| Field | Detail |
|---|---|
| Payer | CMS (Centers for Medicare & Medicaid Services) |
| Policy | Magnetic Resonance Angiography — RETIRED |
| Policy Code | NCD 178 (section 220.3) |
| Change Type | Modified (Retirement formalized) |
| Effective Date | 2026-03-07 |
| Impact Level | Low — no new coverage changes, but high documentation risk if your team is citing the wrong NCD |
| Specialties Affected | Radiology, Cardiology, Vascular Surgery, Neurology |
| Key Action | Update any internal billing guidelines or payer reference sheets that cite NCD 178 or section 220.3 — redirect all MRA coverage policy references to NCD 220.2 |
CMS Magnetic Resonance Angiography Coverage Criteria and Medical Necessity Requirements 2026
The CMS MRA coverage policy no longer lives in section 220.3. It hasn't since June 3, 2010. That's when CMS merged 220.3 into section 220.2, which governs Magnetic Resonance Imaging broadly.
The 2026 modification to NCD 178 doesn't add new medical necessity criteria. It doesn't change reimbursement. What it does is formally document the retirement — making the policy record match what's been operationally true for over 15 years.
For billing teams, the real risk here isn't a coverage change. It's a documentation reference error. If your charge capture workflows, internal billing guidelines, or prior authorization checklists still point to NCD 178 or section 220.3, you're citing a dead policy. A claim denial tied to an incorrect NCD citation is avoidable. Fix the reference.
The active MRA coverage policy now sits under NCD 220.2 at the CMS Medicare Coverage Database. Medical necessity for MRA is evaluated under that section. If you have questions about what criteria apply to a specific MRA claim, that's where you look — not here.
For related coverage, CMS also maintains section 220.2.1 for Magnetic Resonance Spectroscopy. If your team bills MRS alongside MRA, confirm you're referencing 220.2.1 separately. These are distinct policy sections with distinct coverage criteria.
Coverage Indications at a Glance
Because NCD 178 (section 220.3) is retired and carries no independent coverage criteria, there are no indication-level coverage determinations to summarize here. The table below reflects the policy's current state.
| Indication | Status | Relevant Codes | Notes |
|---|---|---|---|
| Magnetic Resonance Angiography (all indications) | See NCD 220.2 | Not listed under NCD 178 | Section 220.3 retired; all MRA coverage criteria merged into NCD 220.2 effective June 3, 2010 |
| Magnetic Resonance Spectroscopy | See NCD 220.2.1 | Not listed under NCD 178 | Cross-reference policy; billed and reviewed separately |
CMS Magnetic Resonance Angiography Billing Guidelines and Action Items 2026
The actual billing work here is about cleaning up your references, not reworking your charge capture from scratch. Here's what to do before and after the March 7, 2026 effective date.
| # | Action Item |
|---|---|
| 1 | Audit your internal MRA billing guidelines now. Search your billing documentation for any reference to NCD 178, section 220.3, or "Magnetic Resonance Angiography" as a standalone NCD. Every one of those references needs to point to NCD 220.2 instead. |
| 2 | Update your payer reference sheets. If your team uses quick-reference sheets for radiology or cardiology billing, replace NCD 178 with NCD 220.2. This is a common source of claim denial errors — citing a retired or incorrect NCD on appeal documentation looks sloppy and can slow resolution. |
| 3 | Check your prior authorization workflows. If your prior authorization process for MRA references section 220.3 in any internal documentation or payer communication templates, update those templates. Prior auth requests that cite retired policy sections create unnecessary friction with Medicare Administrative Contractors. |
| 4 | Brief your radiology and cardiology billing staff. MRA billing is concentrated in those specialties. Make sure the people actually submitting claims know that NCD 178 is retired and that NCD 220.2 is the governing reference. A five-minute team update prevents a pattern of incorrect citations. |
| 5 | Review your NCD 220.2 familiarity. Since that's now the only active MRA coverage policy, your team should know its medical necessity criteria well. Pull the current version from the CMS Medicare Coverage Database and confirm your documentation practices align. If you're unsure how NCD 220.2 applies to your specific MRA claim mix, loop in your compliance officer or billing consultant before questions escalate. |
| 6 | Don't expect reimbursement changes from this update. This modification formalizes a retirement — it doesn't alter coverage criteria or fee schedule rates. If you're seeing MRA reimbursement issues, the source is elsewhere: look at NCD 220.2 criteria, local coverage determination rules from your Medicare Administrative Contractor, or documentation gaps. |
| 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
The policy data for NCD 178 v3 lists no specific CPT codes, HCPCS codes, or ICD-10-CM codes. This is consistent with the policy's retired status — section 220.3 no longer carries independent coding guidance.
Covered CPT Codes
No codes are listed under NCD 178. All MRA-related CPT codes are governed by NCD 220.2. Reference that policy directly for applicable codes and coverage criteria.
Key Cross-References
| Policy Section | Procedure | Where to Find Codes |
|---|---|---|
| NCD 220.2 | Magnetic Resonance Imaging (including MRA) | CMS Medicare Coverage Database — NCD ID 177 |
| NCD 220.2.1 | Magnetic Resonance Spectroscopy | CMS Medicare Coverage Database — NCD ID 287 |
If you need CPT-level code lists for MRA billing under Medicare, pull the current NCD 220.2 documentation directly from CMS. That policy carries the active MRA billing guidelines and medical necessity framework.
The Real Issue With This Change
Here's the thing: a policy retirement that happened in 2010 shouldn't be causing confusion in 2026. But it does.
Billing teams inherit documentation. Reference sheets get copied from year to year. Internal wikis don't always get updated when CMS retires a section. And when a coder or biller looks up NCD 178 and finds a retired policy, they may not know to follow the cross-reference to 220.2 — especially if they're newer to Medicare MRA billing.
The 2026 formalization of this retirement is a signal. CMS is cleaning up its NCD Manual. That's worth using as a prompt to clean up your own documentation. A coverage policy reference error won't always cause a claim denial, but when it does — especially on appeal — it's the kind of error that's hard to explain to a physician or a CFO.
Do the audit now. It takes less time than a single denied claim takes to work.
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