CMS removes separate NCD for MRA
The Centers for Medicare & Medicaid Services (CMS) has decided that because blood-flow determination with MR angiography (MRA) is a “specific application” of MRI, a separate National Coverage Determination is not necessary and the noncoverage language will be removed.
The decision comes eight months after CMS ruled that reimbursing an MRI for blood-flow determination would be made by Medicare contractors. This came after CMS repealed noncoverage language of MRI for blood flow determination last July after it found that evidence no longer supported it.
“While reviewing published scientific evidence for that MRI reconsideration, CMS became aware of evidence that may speak to currently noncovered indications for MRA,” said CMS.
The same will go for MRA indications. Medicare contractors will not cover “all indications of MRA (and MRI) that are not specifically nationally covered or nationally non-covered.”
CMS first outlined coverage guidelines in 1995 and revised them in 1997, 1999 and 2003. Currently, MRI is covered for specific conditions to assess flow in carotid head and neck vessels, peripheral arteries in the lower extremities, abdomen, pelvis and chest. “All other uses of MRA are nationally non-covered unless coverage is specifically indicated,” said the agency.
Currently, “except where other uses have been explicitly authorized by statute or CMS approves an additional preventive service…Medicare does not cover diagnostic testing used for routine screening or surveillance.”
Additionally, CMS stated that diagnostic testing must be ordered by the physicians treating the patient and the test must be ordered for a specified medical condition or problem.
According to the agency, “items or services must be reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member."
CMS said that during the evaluation of the guidelines, the agency looked at how MRA could be used in patients with atrial fibrillation and found that numerous studies have shown that MRA or other modalities were useful.
“The body of evidence suggests that treating physicians can use MRA assessment to manage the care of patients who are known or strongly suspected to have dural arteriovenous fistula and that physicians can use MRA assessment to manage the care of beneficiaries who are candidates for ablation therapy for chronic atrial fibrillation,” CMS said.
The decision comes eight months after CMS ruled that reimbursing an MRI for blood-flow determination would be made by Medicare contractors. This came after CMS repealed noncoverage language of MRI for blood flow determination last July after it found that evidence no longer supported it.
“While reviewing published scientific evidence for that MRI reconsideration, CMS became aware of evidence that may speak to currently noncovered indications for MRA,” said CMS.
The same will go for MRA indications. Medicare contractors will not cover “all indications of MRA (and MRI) that are not specifically nationally covered or nationally non-covered.”
CMS first outlined coverage guidelines in 1995 and revised them in 1997, 1999 and 2003. Currently, MRI is covered for specific conditions to assess flow in carotid head and neck vessels, peripheral arteries in the lower extremities, abdomen, pelvis and chest. “All other uses of MRA are nationally non-covered unless coverage is specifically indicated,” said the agency.
Currently, “except where other uses have been explicitly authorized by statute or CMS approves an additional preventive service…Medicare does not cover diagnostic testing used for routine screening or surveillance.”
Additionally, CMS stated that diagnostic testing must be ordered by the physicians treating the patient and the test must be ordered for a specified medical condition or problem.
According to the agency, “items or services must be reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member."
CMS said that during the evaluation of the guidelines, the agency looked at how MRA could be used in patients with atrial fibrillation and found that numerous studies have shown that MRA or other modalities were useful.
“The body of evidence suggests that treating physicians can use MRA assessment to manage the care of patients who are known or strongly suspected to have dural arteriovenous fistula and that physicians can use MRA assessment to manage the care of beneficiaries who are candidates for ablation therapy for chronic atrial fibrillation,” CMS said.