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 — the National Coverage Determination governing cardiac catheterization performed in other than a hospital setting — with an update date of January 9, 2026. The policy has been retired since 2006, and no specific CPT or HCPCS codes are listed.
This policy entry documents a retired NCD. The underlying section of the NCD Manual was formally repealed on January 12, 2006, with an effective date that predates most current billing teams' careers. The January 9, 2026 update is an administrative modification — a record-keeping action, not a clinical coverage change.
Quick-Reference Table
| Field | Detail |
|---|---|
| Payer | CMS |
| 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 |
| Specialties Affected | Cardiology, Interventional Cardiology, Cardiac Cath Labs operating outside hospital settings |
| Key Action | Confirm your cardiac catheterization billing guidelines reference current LCD-level guidance, not this retired NCD |
CMS Cardiac Catheterization Coverage Policy and Medical Necessity Requirements 2026
NCD 62 is the National Coverage Determination that once governed whether Medicare would cover cardiac catheterization performed in settings other than a hospital — think freestanding cardiac cath labs or physician office-based facilities. That coverage policy no longer exists as an active NCD. It was repealed on January 12, 2006.
The January 9, 2026 modification to NCD 62 in the NCD 62 CMS system is administrative. CMS updated the record, but the substance hasn't changed in nearly 20 years. There are no new medical necessity criteria, no new prior authorization requirements, and no new reimbursement rules attached to this entry.
The real question this raises for your billing team: if NCD 62 is retired, what governs cardiac catheterization billing for non-hospital settings today? The answer is local coverage determinations issued by Medicare Administrative Contractors, not a national policy. Your MAC sets the rules here.
That matters because medical necessity documentation requirements, coverage criteria, and claim denial risks vary by region. What a MAC in the Southeast requires may differ from what a contractor in the Midwest expects. You need to know your MAC's current LCD, not this retired NCD.
CMS Cardiac Catheterization Exclusions and Non-Covered Indications
Because NCD 62 is retired, there are no active coverage exclusions, non-covered indications, or experimental designations to report from this policy. The entire national coverage determination was repealed.
This is worth flagging clearly. A retired NCD doesn't mean the service is non-covered. It means CMS no longer governs coverage at the national level. Coverage decisions fall to your MAC, and in the absence of an LCD, contractors use reasonable and necessary standards under Section 1862(a)(1)(A) of the Social Security Act.
If you're billing cardiac catheterization in an outpatient or non-hospital setting, don't treat the absence of a national policy as open season. Your MAC's local coverage determination and billing guidelines still apply. Check those before submitting claims.
Coverage Indications at a Glance
Because NCD 62 is fully retired and contains no active coverage criteria, there are no indication-level coverage statuses to report from this policy document. The table below reflects that reality.
| Indication | Status | Relevant Codes | Notes |
|---|---|---|---|
| Cardiac catheterization in non-hospital settings | Governed by MAC LCD — no active NCD | Not listed in this policy | NCD repealed January 12, 2006; refer to your MAC's current local coverage determination |
CMS Cardiac Catheterization Billing Guidelines and Action Items 2026
Here's what this administrative update actually requires your team to do:
| # | Action Item |
|---|---|
| 1 | Don't cite NCD 62 in your billing documentation. This coverage policy has been retired since 2006. Referencing it on a claim or in a prior authorization request signals that your documentation process is out of date. Remove any reference to NCD 62 from your billing templates now. |
| 2 | Identify your MAC and pull their current LCD for cardiac catheterization. Since NCD 62 no longer governs this service, your Medicare Administrative Contractor's local coverage determination is your operative document. Find it at the MAC's website or through the CMS LCD database. Do this before January 9, 2026 if you haven't already. |
| 3 | Audit recent claims for cardiac catheterization performed outside a hospital setting. If your team has been submitting claims without referencing current LCD criteria — or worse, referencing a retired NCD — review those claims for claim denial exposure. A denial based on missing medical necessity documentation is avoidable. |
| 4 | Update your charge capture process to reflect MAC-level guidance. Cardiac catheterization billing for non-hospital settings should be built around your MAC's current coverage criteria, not a national policy that hasn't existed since 2006. Update your charge capture workflows to reflect whatever your MAC requires. |
| 5 | Confirm prior authorization requirements with your MAC or commercial payers separately. NCD 62 never addressed prior authorization, and the retired entry certainly doesn't. For commercial payers covering cardiac cath in non-hospital settings, check each payer's current policies independently. CMS reimbursement under Medicare doesn't require prior auth for most diagnostic cardiac procedures, but your MAC may have specific documentation requirements. |
| 6 | Talk to your compliance officer if you're unsure which LCD applies. Some billing teams operate across multiple MAC jurisdictions. If your facilities cross contractor boundaries, you may have different documentation requirements for different patient populations. That's a compliance question, not just a billing one — loop in your compliance officer before the effective date of January 9, 2026. |
| 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 Cardiac Catheterization Under NCD 62
The policy data for NCD 62 does not list any CPT, HCPCS, or ICD-10 codes. This is consistent with a retired NCD — CMS has not attached specific codes to a coverage policy that no longer governs reimbursement decisions.
For cardiac catheterization billing, the relevant CPT codes are assigned by your clinical team based on the specific procedure performed — left heart cath, right heart cath, combined, with or without coronary angiography. Those codes need to map to your MAC's current LCD criteria, not to this retired NCD.
Do not use NCD 62 as a code reference. It has none to offer.
What This Really Means for Your Team
Here's the honest take on this update: it changes nothing about how you bill cardiac catheterization today. The Centers for Medicare & Medicaid Services retired this coverage policy almost 20 years ago. The January 9, 2026 record update is a housekeeping action.
But that doesn't mean you should ignore it. If this update appeared in your policy monitoring queue, use it as a trigger to confirm your current process is actually grounded in current guidance. A surprising number of billing teams carry outdated NCD references in their documentation templates long after those policies are retired.
The real risk isn't this update. The risk is discovering — during a MAC audit or after a claim denial — that your cardiac catheterization billing process was referencing dead policy. That's an avoidable problem.
Pull your MAC's LCD. Confirm your medical necessity documentation matches current criteria. Update your charge capture. Then move on.
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