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National Coverage Determination (NCD)

Transcendental Meditation

30.5

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Tracking Information

Publication Number
100-3
Manual Section Number
30.5
Manual Section Title
Transcendental Meditation
Version Number
1
Effective Date of this Version
11/11/1995
Ending Effective Date of this Version
Implementation Date
11/11/1995
Implementation QR Modifier Date

Description Information

Benefit Category
Incident to a physician's professional Service
Physicians' Services


Please Note: This may not be an exhaustive list of all applicable Medicare benefit categories for this item or service.

Item/Service Description

Transcendental Meditation (TM) is a skill that is claimed to produce a state of rest and relaxation when practiced effectively. Typically, patients are taught TM techniques over the course of several sessions by persons trained in TM. The patient then uses the TM technique on his or her own to induce the relaxed state. Proponents of TM have urged that Medicare cover the training of patients to practice TM when it is medically prescribed as treatment for mild hypertension, as adjunctive therapy in the treatment of essential hypertension, or as the sole or adjunctive treatment of anxiety and other psychological stress-related disorders.
Indications and Limitations of Coverage

After review of this issue, CMS has concluded that the evidence concerning the medical efficacy of TM is incomplete at best and does not demonstrate effectiveness and that a professional level of skill is not required for the training of patients to engage in TM.

Although many articles have been written about application of TM for patients with certain forms of hypertension and anxiety, there are no rigorous scientific studies that demonstrate the effectiveness of TM for use as an adjunct medical therapy for such conditions. Accordingly, neither TM nor the training of patients for its use are covered under the Medicare program.
Cross Reference
Claims Processing Instructions

Transmittal Information

Transmittal Number
79
Revision History

09/1995 - Reflected noncoverage of transcendental meditation and cost of training patients to use it. Effective date 10/11/1995. (TN 79)
Other

National Coverage Analyses (NCAs)

This NCD has been or is currently being reviewed under the National Coverage Determination process. The following are existing associations with NCAs, from the National Coverage Analyses database.

Coding Analyses for Labs (CALs)

This NCD has been or is currently being reviewed under the National Coverage Determination process. The following are existing associations with CALs, from the Coding Analyses for Labs database.

Additional Information

Other Versions
Title Version Effective Between
Transcendental Meditation 1 11/11/1995 - N/A You are here
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Reasons for Denial
Note: This section has not been negotiated by the Negotiated RuleMaking Committee. It includes CMS’s interpretation of it’s longstanding policies and is included for informational purposes. Tests for screening purposes that are performed in the absense of signs, symptoms, complaints, or personal history of disease or injury are not covered except as explicity authorized by statue. These include exams required by insurance companies, business establishments, government agencies, or other third parties. Tests that are not reasonable and necessary for the diagnosis or treatment of an illness or injury are not covered according to the statue. Failure to provide documentation of the medical necessity of tests may result in denial of claims. The documentation may include notes documenting relevant signs, symptoms, or abnormal findings that substantiate the medical necessity for ordering the tests. In addition, failure to provide independent verification that the test was ordered by the treating physician (or qualified nonphysician practitioner) through documentation in the physician’s office may result in denial. A claim for a test for which there is a national coverage or local medical review policy will be denied as not reasonable and necessary if it is submitted without an ICD-9-CM code or narrative diagnosis listed as covered in the policy unless other medical documentation justifying the necessity is submitted with the claim. If a national or local policy identifies a frequency expectation, a claim for a test that exceeds that expectation may be denied as not reasonable and necessary, unless it is submitted with documentation justifying increased frequency. Tests that are not ordered by a treating physician or other qualified treating nonphysician practitioner acting within the scope of their license and in compliance with Medicare requirements will be denied as not reasonable and necessary. Failure of the laboratory performing the test to have the appropriate Clinical Laboratory Improvement Act of 1988 (CLIA) certificate for the testing performed will result in denial of claims.
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