CMS Retired NCD 62 for Cardiac Catheterization in Non-Hospital Settings — What Billing Teams Need to Know in 2026

TL;DR: The Centers for Medicare & Medicaid Services modified NCD 62 governing cardiac catheterization performed in other than a hospital setting, with a policy record effective date of 2026-01-09. The underlying section was formally repealed in 2006 — but this retirement has real implications for how your billing team documents coverage decisions today.

NCD 62 in the Medicare system has been a ghost on the books for nearly two decades. The section was repealed January 12, 2006, and the current policy record reflects that repeal with a revision date of March 9, 2023 and implementation on April 10, 2023. Now, with the 2026-01-09 effective date attached to this record, billing teams are asking the right question: does a retired NCD still shape cardiac catheterization billing in non-hospital settings? The answer is more complicated than a simple repeal note suggests.

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Quick-Reference Table

Field	Detail Copy
Payer	CMS (Centers for Medicare & Medicaid Services)
Policy	Cardiac Catheterization Performed in Other Than a Hospital Setting — RETIRED
Policy Code	NCD 62
Change Type	Modified
Effective Date	2026-01-09
Impact Level	Low (direct) — Medium (indirect, for teams that relied on NCD 62 for coverage justification)
Specialties Affected	Cardiology, Interventional Cardiology, Ambulatory Surgical Centers (ASCs)
Key Action	Remove NCD 62 from any internal coverage justification templates and confirm MAC-level LCD guidance governs your cardiac catheterization billing in non-hospital settings

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CMS Cardiac Catheterization Coverage Policy — What NCD 62 Actually Said (and Why It No Longer Applies)

NCD 62 once served as the national coverage determination governing cardiac catheterization performed outside a hospital setting. When CMS repealed it on January 12, 2006, the agency effectively removed a federal-level coverage policy for this service in non-hospital environments.

That repeal did not create a coverage vacuum. It shifted authority to Medicare Administrative Contractors. Your MAC now sets the rules on medical necessity, coverage criteria, and billing guidelines for cardiac catheterization performed in ASCs and other non-hospital settings.

The 2026-01-09 record update does not reinstate NCD 62. It formalizes the retired status in CMS's NCD Manual under the current revision cycle. If your billing team has any internal policy documents that reference NCD 62 as active authority, those documents are wrong — and have been wrong for nearly 20 years.

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CMS Cardiac Catheterization Coverage Criteria and Medical Necessity Requirements 2026

Because NCD 62 is retired, there are no national-level medical necessity criteria governing cardiac catheterization in non-hospital settings under this policy code. This is the practical reality your billing team needs to work with.

Medical necessity determinations now live at the MAC level. That means coverage policy for this service varies by jurisdiction. Your MAC may have issued a local coverage determination that sets specific criteria for when cardiac catheterization in an ASC or office-based lab qualifies for Medicare reimbursement.

Pull your MAC's current LCD for cardiac catheterization before assuming coverage. The absence of an NCD does not mean the service is automatically covered — it means your MAC decides. If you are billing across multiple jurisdictions, you may face different standards in each one. That inconsistency is exactly why teams get surprised by claim denial.

Prior authorization requirements under Medicare for cardiac catheterization depend on your MAC and the specific setting. CMS does not mandate prior auth at the NCD level here — again, because there is no active NCD. Check your MAC's billing guidelines directly, and do not assume the absence of a national prior authorization requirement means no local requirement exists.

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Coverage Indications at a Glance

Because NCD 62 is retired and lists no active coverage criteria, the table below reflects the current state of national coverage under this policy code. MAC-level LCDs govern all active determinations.

Indication	Status	Relevant Codes	Notes Copy
Cardiac catheterization in a non-hospital setting (national level)	Not governed by NCD 62	No codes listed in NCD 62	Retired January 12, 2006. Refer to your MAC's LCD for current medical necessity criteria
Cardiac catheterization in a hospital setting	Never governed by NCD 62	N/A	Hospital-setting catheterization was always outside the scope of this NCD

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CPT, HCPCS, and ICD-10 Codes for Cardiac Catheterization Under NCD 62

Covered CPT Codes

The policy document for NCD 62 lists no applicable codes. This is consistent with a retired NCD — CMS does not maintain a code set for a repealed coverage determination.

Code	Type	Description Copy
—	—	No codes listed in NCD 62. See your MAC's LCD for applicable cardiac catheterization codes

A Note on Codes Your Team Should Be Using

While NCD 62 carries no codes, your cardiac catheterization billing in non-hospital settings does involve specific CPT codes that your MAC's LCD will reference. The policy data for NCD 62 does not authorize us to list those codes here as covered under this NCD — because the NCD is retired.

Do not use NCD 62 as a code authority. Pull the active MAC LCD and build your charge capture from that document.

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CMS Cardiac Catheterization Billing Guidelines and Action Items 2026

The retirement of NCD 62 is old news clinically, but it has real administrative consequences if your team has been using outdated reference materials. Here is what to do now.

Copy Action Items

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Why a Retired Policy Record Still Deserves Your Attention

Here is the honest take: a retired NCD getting a 2026-01-09 record update sounds like administrative housekeeping. For most teams, it is.

But billing teams make expensive mistakes when they assume a retired policy is irrelevant. The real issue is that NCD 62 created a gap. When CMS repealed it in 2006, they left cardiac catheterization in non-hospital settings without a national coverage determination. That gap is still there today.

Without an active NCD, there is no uniform national standard for medical necessity in this setting. That is good news and bad news. Good news: your MAC may have more flexible criteria than a strict NCD would impose. Bad news: your exposure to claim denial is higher when coverage policy varies by jurisdiction and your billing team is not tracking each MAC's current LCD.

If you are not sure how your MAC governs this service, talk to your compliance officer before assuming coverage. The financial exposure on cardiac catheterization procedures is significant enough that a wrong assumption costs real money.

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