News | January 07, 2008

Public Forum on CTA Reimbursement to Close Jan. 12

January 8, 2008 – The cardiac imaging community has until Jan. 12 to contribute to the Centers for Medicare and Medicaid Services (CMS) public comments forum regarding CMS’ proposed National Coverage Decision (NCD) that would limit reimbursement for coronary CTA to just two clinical indications.

In the decision, CMS states that “[t]he evidence is inadequate to conclude that cardiac computed tomographic angiography (CTA) is reasonable and necessary under section 1862(a)(1)(A) for the diagnosis of coronary artery disease (CAD).”

Under the proposal, the only two reimbursable indications would be CTA for the diagnosis of CAD for symptomatic patients with chronic stable angina at intermediate risk of CAD; or symptomatic patients with unstable angina at a low risk of short-term death and intermediate risk of CAD. CMS would only provide the coverage with evidence development (CED) appropriate for these indications based on the specific standards.

Many clinicians in the cardiac community argue that CMS has not examined the full impact this proposal will have on the Medicare beneficiary, and are urging others to send in their comments to encourage CMS to suspend its proposed NCD for two years and consider more than 25 studies published in 2007 that were left out of the agency’s assessment of coronary CTA.

To contribute to the public comments forum, go to http://www.cms.hhs.gov/mcd/public_comment.asp?nca_id=206&basketitem=nca:... tomographic angiography:open:new:5.

For more information: www.cms.hhs.gov

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Figure 4 for the study. Images of a 65-year-old man (patient 6). (a) Cardiac MRI perfusion shows perfusion deficit of anterior/anterolateral wall attributed to left anterior descending artery/left circumflex artery (*). (b) CT coronary angiography. (c) Coronary angiography, left anterior oblique projection with caudal angulation. (d) Three-dimensional image fusion helped refine diagnosis: perfusion deficits (*) were most likely caused by narrow first diagonal branch and its first, stented side branch.

Figure 4 for the study. Images of a 65-year-old man (patient 6). (a) Cardiac MRI perfusion shows perfusion deficit of anterior/anterolateral wall attributed to left anterior descending artery/left circumflex artery (*). (b) CT coronary angiography. (c) Coronary angiography, left anterior oblique projection with caudal angulation. (d) Three-dimensional image fusion helped refine diagnosis: perfusion deficits (*) were most likely caused by narrow first diagonal branch and its first, stented side branch (arrowhead). Retrospectively, denoted lesion could also be found at CT coronary angiography and coronary angiography (arrowheads in b and c, respectively). CT FFR = CT-derived fractional flow reserve, LGE = late gadolinium enhancement. Image courtesy of RSNA, Radiology.

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