National Coverage Determinations
E116582
National Coverage Determinations are nationwide Medicare policies that define whether and under what conditions specific medical services, procedures, or technologies are covered for beneficiaries.
All labels observed (2)
| Label | Occurrences |
|---|---|
| Medicare National Coverage Determinations Manual | 1 |
| National Coverage Determinations canonical | 1 |
How this entity was disambiguated
This entity first appeared as the object of triple T986288 — resolving that mention is where its identity was fixed. The disambiguator weighed these candidate entities and picked the highlighted one (or “None”, minting a new entity). This is how homonymy is resolved: the same surface form can point to different entities.
NED1
Entity disambiguation (via context triple)
gpt-5-mini-2025-08-07
Target entity: National Coverage Determinations Context triple: [Centers for Medicare & Medicaid Services, issues, National Coverage Determinations]
-
A.
Centers for Medicare & Medicaid Services
The Centers for Medicare & Medicaid Services is a U.S. federal agency within the Department of Health and Human Services that administers the nation’s major public health insurance programs, including Medicare and Medicaid, and sets key standards for healthcare quality and reimbursement.
-
B.
Medicare Part D
Medicare Part D is the U.S. federal program that provides outpatient prescription drug coverage to Medicare beneficiaries through private insurance plans.
-
C.
Medicare Part C
Medicare Part C, also known as Medicare Advantage, is a program through which private insurance plans provide Medicare-covered benefits and often additional services to eligible beneficiaries.
-
D.
Center for Consumer Information and Insurance Oversight
The Center for Consumer Information and Insurance Oversight is a U.S. federal office within the Centers for Medicare & Medicaid Services that regulates private health insurance markets and implements key consumer protection and coverage provisions of national health reform.
-
E.
Medicare Part B
Medicare Part B is the component of the U.S. federal health insurance program that helps cover medically necessary outpatient services, such as doctor visits, preventive care, and certain medical supplies for eligible beneficiaries.
- F. None of above. chosen
- G. Unsure - the case is ambiguous/there is not enough information to decide.
NED2
Entity disambiguation (via description)
gpt-5-mini-2025-08-07
Target entity: National Coverage Determinations Target entity description: National Coverage Determinations are nationwide Medicare policies that define whether and under what conditions specific medical services, procedures, or technologies are covered for beneficiaries.
-
A.
Centers for Medicare & Medicaid Services
The Centers for Medicare & Medicaid Services is a U.S. federal agency within the Department of Health and Human Services that administers the nation’s major public health insurance programs, including Medicare and Medicaid, and sets key standards for healthcare quality and reimbursement.
-
B.
Medicare Part D
Medicare Part D is the U.S. federal program that provides outpatient prescription drug coverage to Medicare beneficiaries through private insurance plans.
-
C.
Medicare Part C
Medicare Part C, also known as Medicare Advantage, is a program through which private insurance plans provide Medicare-covered benefits and often additional services to eligible beneficiaries.
-
D.
Center for Consumer Information and Insurance Oversight
The Center for Consumer Information and Insurance Oversight is a U.S. federal office within the Centers for Medicare & Medicaid Services that regulates private health insurance markets and implements key consumer protection and coverage provisions of national health reform.
-
E.
Medicare Part B
Medicare Part B is the component of the U.S. federal health insurance program that helps cover medically necessary outpatient services, such as doctor visits, preventive care, and certain medical supplies for eligible beneficiaries.
- F. None of above. chosen
Statements (50)
| Predicate | Object |
|---|---|
| instanceOf |
Medicare coverage policy
ⓘ
health insurance policy instrument ⓘ |
| abbreviation | NCDs ⓘ |
| administeredBy |
Centers for Medicare & Medicaid Services
ⓘ
surface form:
Centers for Medicare & Medicaid Services Coverage and Analysis Group
|
| affects |
Medicare claims payment
ⓘ
beneficiary access to services ⓘ |
| appliesTo |
Medicare Part A
ⓘ
Medicare Part B ⓘ Medicare beneficiaries ⓘ Medicare ⓘ
surface form:
Original Medicare
|
| basedOn | reasonable and necessary standard under the Social Security Act ⓘ |
| bindingOn |
Administrative Law Judges in Medicare appeals
ⓘ
Medicare Administrative Contractors ⓘ Medicare Advantage plans for basic benefits ⓘ Medicare Appeals Council ⓘ Qualified Independent Contractors in Medicare appeals ⓘ |
| canBeRequestedBy |
beneficiary advocacy organizations
ⓘ
external stakeholders ⓘ manufacturers of medical technologies ⓘ professional medical societies ⓘ |
| defines |
conditions under which a service is covered by Medicare
ⓘ
national Medicare coverage criteria ⓘ whether a service is covered by Medicare ⓘ |
| developmentProcessIncludes |
draft decision memorandum
ⓘ
evidence review ⓘ final decision memorandum ⓘ public comment period ⓘ |
| documentedIn |
National Coverage Determinations
self-linksurface differs
ⓘ
surface form:
Medicare National Coverage Determinations Manual
|
| governs | Medicare coverage of specific items and services ⓘ |
| issuedBy | Centers for Medicare & Medicaid Services ⓘ |
| jurisdiction |
United States of America
ⓘ
surface form:
United States
|
| legalBasis | Title XVIII of the Social Security Act ⓘ |
| mayInclude | coverage with evidence development requirements ⓘ |
| maySpecify |
documentation requirements
ⓘ
facility requirements ⓘ frequency limitations ⓘ patient eligibility criteria ⓘ provider qualifications ⓘ |
| overrides | conflicting Local Coverage Determinations ⓘ |
| publishedOn | CMS website ⓘ |
| regulates |
coverage of diagnostic tests
ⓘ
coverage of medical procedures ⓘ coverage of medical technologies ⓘ coverage of therapeutic services ⓘ |
| relatedTo | Local Coverage Determinations ⓘ |
| scope | nationwide ⓘ |
| updatedBy | Centers for Medicare & Medicaid Services through formal reconsideration ⓘ |
| usedBy |
Medicare contractors for claims adjudication
ⓘ
clinicians for Medicare coverage guidance ⓘ hospitals for Medicare billing and coverage decisions ⓘ |
How these facts were elicited
The pipeline generated the facts above by prompting gpt-5.1 with this entity's name + description and the instruction below.
Instruction
You are a knowledge base construction expert. Given a subject entity and a description of it, return factual statements that you know for the subject as a JSON list of dictionaries(triples), where keys must be "subject", "predicate" and "object". The number of facts may be very high, between 25 to 50 or more, for very popular subjects. For less popular subjects, the number of facts can be very low, like 5 or 10. # Requirements - If you don't know the subject at all, return an empty list. - If the subject is not a named entity, return an empty list. - Include at least one triple where predicate is "instanceOf". - Do not get too wordy. - Separate several objects into multiple triples with one object.
Input
Subject: National Coverage Determinations Description of subject: National Coverage Determinations are nationwide Medicare policies that define whether and under what conditions specific medical services, procedures, or technologies are covered for beneficiaries.
Referenced by (2)
Full triples — surface form annotated when it differs from this entity's canonical label.
National Coverage Determinations
→
documentedIn
→
National Coverage Determinations
self-linksurface differs
ⓘ
this entity surface form:
Medicare National Coverage Determinations Manual