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March 12, 2008
The Centers for Medicare & Medicaid Services (CMS) today decided
NOT to move forward with its proposed National Coverage Decision
(NCD) that would have limited Medicare coverage of Computed Tomographic
Angiography (CTA) to ONLY those instances where CTA is used as part
of an ongoing clinical study meeting certain standards set by CMS.
According to CMS: “We have decided that no national coverage
determination on the use of cardiac computed tomography angiography
for coronary artery disease is appropriate at this time and that
coverage should be determined by local contractors through the local
coverage determination process or case-by-case adjudication.”
"The American College of Cardiology (ACC) applauds CMS' decision
not to move forward with this proposal," says ACC CEO Jack
Lewin. "Medicare beneficiaries can continue to have the access
they deserve to an advanced, non-invasive clinical tool that has
been clinically proven to be effective in diagnosing Coronary Artery
Disease (CAD)."
Since CMS's initial proposal to limit CTA coverage in December
2007, the ACC has been working as part of a multi-society effort
to oppose the draft decision for the following reasons:
- The NCD would have overruled and replaced Medicare Carrier
Local Coverage Decisions (LCDs) made in all fifty states that
provide coverage of CTA for indications established as appropriate.
- The decision to only permit CTA Coverage with Evidence Development
(CED) would have -paradoxically-hindered the currently robust
clinical research surrounding CTA that is already occurring.
- The research used in formulating the NCD appeared to be much
older and associated with CTA technologies no longer considered
by medical societies as appropriate for use in diagnosing CAD.
For example, most of the research cited by CMS focused on CTA
machines that provide 4, 8, or 16-slice images, whereas currently
64-slice or better imaging devices are considered the clinical
standard for use in diagnosing CAD.
- By limiting Medicare coverage for CTA, CMS would have ignored
the substantial amount of clinical evidence supporting the use
of CTA in diagnosing CAD
The ACC will continue to work to develop and promote clinical appropriateness
criteria and clinical decision support tools that will promote evidence-based
applications of this valuable imaging technology. For more information,
contact Sergio Santiviago at ssantivi@acc.org.
To view the final rule, go to: http://www.cms.hhs.gov/MCD/viewdecisionmemo.asp?id=206.
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