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Medical Coding News Archives

CTA Coverage Not to Be Limited As Proposed

April 8, 2008:
Cardiologists and radiologists got a reprieve from further cuts to medical imaging reimbursement when the Centers for Medicare and Medicaid Services (CMS) announced it will not implement proposed changes that would have drastically limited Medicare coverage of computed tomographic angiography (CTA). CMS released “Coverage Decision Memorandum for Cardiac Computed Tomographic Angiography for the Diagnosis of Coronary Artery Disease” (CAG-00385N) on March 12, 2008.

CMS initially proposed to limit CTA coverage in December 2007. The proposal included eliminating reimbursement for CTA altogether with few exceptions, but hundreds of comments during the comment period effectively trounced the proposal. Commenters agreed that using cardiac CTA saves money and reduces the number of invasive cardiac catheterizations and other diagnostic tests. CMS also received comments from professional societies, including the American College of Cardiology and the American College of Radiology, which disagreed with CMS’s proposal and expressed concern that it would limit patient access to an advanced, noninvasive tool that is clinically proven to be effective in diagnosing coronary artery disease.

The term computed tomographic angiography describes noninvasive imaging of the arteries with various types of computed tomography (CT) machines (e.g., multislice, multidetector, and dual source CT.) CTA use has increased due to advances in technology and use of the imaging machines outside the hospital settings. Although there are other uses of CTA, this decision focuses only on the use of CTA to evaluate the coronary arteries in patients with symptomatic coronary artery disease (e.g., chest pain). Imaging performed on asymptomatic patients would be considered screening and is not one of the 12 preventive services benefits available under the Medicare program. Screening is performed to detect unrecognized, asymptomatic disease.

CMS announced in the decision memo that it will not change the National Coverage Determination Manual section titled “Computed Tomography” (Pub. 100-3, 220.1), which discusses general uses of CT. The policy does not specifically address the use of CTA to diagnose CAD because it was not used in clinical practice at the time the policy was last updated in 1985. Because CTA is not addressed in national policy, coverage is left to the discretion of the local contractors. Coverage will be determined by local Medicare contractors through case-by-case adjudication and local coverage determinations. The majority of local contractors have local coverage determination (LCD) policies on CTA.

These reductions were proposed in addition to significant reductions in Medicare reimbursement for outpatient imaging included in the Deficit Reduction Act of 2005 (DRA). Beginning January 1, 2006, CMS implemented a payment reduction on the technical component (TC) of certain diagnostic imaging procedures, cutting reimbursement by up to 50 percent for many imaging procedures, such as CTA and brain or spinal MRI. (The reduction applies to TC-only services and the TC portion of global services and does not apply to professional component [PC] services.)

Last-minute congressional action temporarily stalled the 10 percent Medicare physician payment cut scheduled to take effect on January 1, 2008. The Medicare, Medicaid and SCHIP Extension Act of 2007 replaced the scheduled 10.1 percent reduction in Medicare Part B payments with a 0.5 percent increase for six-months, or until June 30, 2008. Significant cuts remain scheduled for July 1, 2008, so without further action physician Medicare payment rates will be reduced 10 percent, plus an additional 5 percent on January 1, 2009. Recent legislation (Save Medicare Act of 2008) has been introduced to eliminate the scheduled Medicare physician payment cut for 18 months.

Sarah A. Serling, CPC, CPC-H, CPC-I, CCS-P, CCS
Clinical/Technical Editor


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