Coverage Policies

Title XVIII of the Social Security Act (the Act) specifies broad categories of services covered by Medicare (e.g., physician and hospital services), excluded services (e.g., convenience items, cosmetic surgery, eyeglasses, most preventive services), and exceptions to exclusions (e.g., screening mammography). Section 1862(a) of the Act provides HCFA with the discretionary authority for determining coverage based on whether items or services are reasonable and necessary for the diagnosis and treatment of an illness or injury. HCFA is responsible for tracking emerging technologies and patterns of care to determine applicability of existing coverage policy and to assess the need for policy change. HCFA promotes an integrated approach to coverage policy through partnerships with entities such as the Agency for Health Care Policy and Research, Food and Drug Administration, Veterans Administration-CHAMPUS, American Medical Association, National Institutes of Health, specialty-specific professional organizations, specialty advocacy groups, and health care providers, suppliers, and manufacturers. Check out FDA's new GATEWAY SITE to find out how HCFA and FDA work together for high quality healthcare. To find out more about our coverage policies, click on the links below: Redesign of the Medicare Coverage Process to make it more open, understandable, and predictable. Re-evaluation of criteria used for Medicare approval of Transplant Centers. Adaption of national coverage and administrative policies for Clinical Diagnostic Laboratory Tests using negotiated rulemaking. Personnel Directory (provides name and E-mail address of lead analyst and team coordinator for each coverage issue) Coverage Issues Manual

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Last Updated January 4, 2000