Coverage | CMS

Coverage | CMS [Skip to main content](#skipNavTarget) ** [](https://www.cms.gov/) Centers for Medicare & Medicaid Services ## [CMS Newsroom](https://www.cms.gov/about-cms/contact/newsroom) ## Search CMS.gov SearchSearch** Popular terms * Physician Fee Schedule** * Local Coverage Determination** * Medically Unlikely Edits** * Telehealth** * Covid-19** * Agents and Brokers** ** ** * [Home](https://www.cms.gov/medicare/coding-billing/guide-medical-technology-companies-other-interested-parties) * [Getting Started](https://www.cms.gov/cms-guide-medical-technology-companies-and-other-interested-parties/getting-started) * [Overview of Medicare](https://www.cms.gov/cms-guide-medical-technology-companies-and-other-interested-parties/getting-started/overview-medicare) * [Overview of CMS Groups](https://www.cms.gov/cms-guide-medical-technology-companies-and-other-interested-parties/getting-started/overview-cms-groups) * [Coding](https://www.cms.gov/cms-guide-medical-technology-companies-and-other-interested-parties/coding) * [Overview of Coding and Classification Systems](https://www.cms.gov/cms-guide-medical-technology-companies-and-other-interested-parties/coding/overview-coding-classification-systems) * [Considerations](https://www.cms.gov/cms-guide-medical-technology-companies-and-other-interested-parties/coding/considerations) * [Coverage](https://www.cms.gov/cms-guide-medical-technology-companies-and-other-interested-parties/coverage) * [Medicare Coverage of Items and Services](https://www.cms.gov/cms-guide-medical-technology-companies-and-other-interested-parties/coverage/medicare-coverage-items-and-services) * [National Coverage Determination Process & Timeline](https://www.cms.gov/cms-guide-medical-technology-companies-and-other-interested-parties/coverage/national-coverage-determination-process-timeline) * [Local Coverage Determination Process and Timeline](https://www.cms.gov/cms-guide-medical-technology-companies-and-other-interested-parties/coverage/local-coverage-determination-process-and-timeline) * [Payment](https://www.cms.gov/cms-guide-medical-technology-companies-and-other-interested-parties/payment) * [IPPS](https://www.cms.gov/cms-guide-medical-technology-companies-and-other-interested-parties/payment/ipps) * [OPPS](https://www.cms.gov/cms-guide-medical-technology-companies-and-other-interested-parties/payment/opps) * [CDLT](https://www.cms.gov/cms-guide-medical-technology-companies-and-other-interested-parties/payment/cdlt) * [ESRD](https://www.cms.gov/cms-guide-medical-technology-companies-and-other-interested-parties/payment/esrd) * [Physician Fee Schedule](https://www.cms.gov/cms-guide-medical-technology-companies-and-other-interested-parties/payment/physician-fee-schedule) * [Part B Drugs and Biologicals](https://www.cms.gov/cms-guide-medical-technology-companies-and-other-interested-parties/payment/part-b-drugs) * [DMEPOS](https://www.cms.gov/cms-guide-medical-technology-companies-and-other-interested-parties/payment/durable-medical-equipment-prosthetics-orthotics-and-supplies) * [Rulemaking Schedule](https://www.cms.gov/cms-guide-medical-technology-companies-and-other-interested-parties/payment/rulemaking-schedule) # Coverage Note: This guide does not reflect the issuance of the proposed procedural notice of the Technical Coverage of Emerging Technologies (TCET) coverage pathway. This guide will be updated to reflect the TCET information after the updated subsequent final notice. Medicare provides coverage for health care items and services for the program’s beneficiaries. Medicare covers items and services when specifically required by law or by using several policy mechanisms that include National Coverage Determinations (NCDs), Local Coverage Determinations (LCDs), rulemaking, and claim-by-claim adjudication. This section provides an overview of different coverage pathways, describes the processes for requesting an NCD or LCD, and lists key considerations for interested parties pursuing Medicare coverage of new items or services. **IMPORTANT:**This information is only intended as a general summary and is not intended to grant rights or impose obligations nor is it intended to establish or change any substantive legal standards established under statutory or regulatory authority. This site contains references and links to certain statutes, regulations, and other policy materials, but it is not intended to be an all-inclusive listing or take the place of applicable statutory law or regulations. We encourage readers to review the specific statutes, regulations, and other interpretive materials for a full and accurate statement of their contents. Page Last Modified: 09/10/2024 06:01 PM [Help with File Formats and Plug-Ins](https://www.cms.gov/about-cms/web-policies-important-links/help)

Items and services are covered when they are deemed medically necessary according to established criteria.

Coverage is limited to items and services that are reasonable and necessary for the diagnosis or treatment of illness or injury. Services not described in the policy documentation will not be covered.

Complete medical records must be available to justify the medical necessity of services rendered. Prior authorization may be required depending on the service provided.