CMS proposes to restrict cardiac CTA reimbursements, seeks comments

CMS aims to cutback reimbursements for CTA. Source: GlobalSpec

The Centers for Medicare & Medicaid Services (CMS) has proposed restrictions for the coverage of cardiac CT angiography (CTA), stating Medicare beneficiaries can only receive reimbursements with two clinical indications of coronary artery disease (CAD) under the coverage with evidence development process. 

“Our proposed policy provides consistent coverage and uniform access to CTA for Medicare beneficiaries while stimulating the additional research needed to develop evidence on patient outcomes,” said CMS Acting Administrator Kerry Weems. CMS proposed that the risk of CAD be determined by the Framingham risk score, developed using data from an NIH-sponsored study.

The agency said its proposed National Coverage Determination, introduced on Dec. 13, 2007, defines the questions that studies must address and the standards the studies must meet as a condition of coverage. Both CMS and the Agency for Healthcare Research and Quality believe the questions and standards meet the requirements of Section 1862(a)(1)(E) of the Medicare statute that allows coverage in connection with certain medical research when the evidence for coverage is still preliminary.

CMS will receive public response pursuant to Section 731 of the Medicare Modernization Act until Jan.12. Comments can be submitted at: https://www4.cms.hhs.gov/InfoExchange/02_publiccomments.asp#TopOfPage

CMS believes that the proposal could be enacted as early as March 13.