Medicare reimbursement for computed tomographic angiography will not be limited, according to the Centers for Medicare and Medicaid Services.
The federal agency never had a formal policy on CTA, but the majority of local Medicare contractors had been covering the procedure. In July 2007, the CMS said it was starting a formal analysis of CTA with an eye toward potentially limiting its coverage. In December 2007, the CMS posted a formal proposal to do just that.
Under the proposal, Medicare would have covered only CTA for symptomatic patients with chronic angina at intermediate risk of coronary artery disease, and symptomatic patients with unstable angina at low risk of short-term death or intermediate risk of CAD.
Reimbursement would be made only for patients getting CTA as part of a CMS-approved clinical trial.
After reviewing the current literature, however, the CMS said that it had decided that “coverage should be determined by local contractors through the local coverage determination process or case-by-case adjudication.”
The decision applies only to use of CTA for evaluation of coronary arteries in patients with symptomatic coronary artery disease, according to the CMS. CTA for asymptomatic patients would not be covered under Medicare, as it is considered a screening test.
The American College of Cardiology, which submitted comments opposing the CMS proposal, said it was pleased with the agency's decision. “Medicare beneficiaries can continue to have the access they deserve to an advanced, noninvasive clinical tool that has been clinically proven to be effective in diagnosing coronary artery disease,” Jack Lewin, ACC CEO, said in a statement.
The ACC, along with five other professional societies—the American Society of Nuclear Cardiology, the American College of Radiology, the Society for Cardiovascular Angiography and Interventions, the North American Society for Cardiac Imaging, and the Society of Cardiovascular Computed Tomography—argued that the CMS had relied on studies of older technology, such as 4-, 8-, and 16-slice imaging.
According to the ACC, 64-slice or higher machines are now considered the clinical standard for diagnosing CAD.
The CMS received 670 comments after the proposed decision was published. According to the CMS, 649 of the comments were opposed.
There were 10 comments in favor, and the rest provided no direction for coverage. Among those who backed the CMS' proposal to limit CTA reimbursement: America's Health Insurance Plans.
Even so, Aetna, Humana, UnitedHealth Group, and 14 Blue Cross Blue Shield plans, currently cover CTA, according to the American College of Radiology.
Almost half of those who submitted comments to the CMS said that CTA would save money and reduce the number of invasive tests done. The agency said it generally does not consider cost when weighing a national coverage determination, but that it would be interested in knowing whether CTA prevented the need for additional procedures. The CMS could not find any such evidence, however.