CMS Issues Final Decision Not to Limit Coverage of CTA

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.

The American College of Cardiology * Heart House * 2400 N Street, NW * Washington, DC 20037-1153

Phone: (800) 253-4636, or (202) 375-6000 Fax: (202) 375-7000