CMS has decided to make no change to Section 220.1 of the existing National Coverage Determination Manual titled “Computed Tomography” (PUB 100-3, 220.1). The link to the CMS announcement is:
https://www.cms.hhs.gov/mcd/viewdecisionmemo.asp?id=206
The summary of the decision is as follows:
Conclusions
In summary, there is uncertainty regarding any potential health benefits or patient management alterations from including coronary CTA in the diagnostic workup of patients who may have CAD. No adequately powered study has established
that improved health outcomes can be causally attributed to coronary CTA for any well-defined clinical indication, and the body of evidence is of overall limited quality and limited applicability to Medicare patients with typical comorbidities in community practice. The primary safety concerns with cardiac CTA are the exposure to radiation and the use of contrast and β blocker medications. However, while public comments and specialty society opinions following the CMS proposed decision to use CED did not dispel the uncertainty of the test’s clinical utility, they did strongly favor maintaining the local coverage policies for CTA. In light of this, CMS has decided to make no change in the current NCD.
CMS wishes to foster the necessary health outcomes research and establish evidence-based diagnostic strategies by encouraging affected Medicare patients to enroll in rigorously designed studies. Absent any reported additional serious patient harms, further national coverage reconsideration of coronary CTA will depend upon peer-reviewed publication and critical evaluation of convincing new evidence.
Additionally, we believe that current guidelines are inadequate to provide appropriate guidance to patients and providers as to the appropriate inclusion of CTA into the diagnostic milieu in the workup of chest pain. We are concerned that providers are using CTA as an additional test added to exercise testing and nuclear imaging rather than thoughtfully considering the appropriate mix of these tests. We encourage the specialty societies to quickly develop this type of guidance.
Summary
The Centers for Medicare and Medicaid Services (CMS) has decided to make no change to section 220.1 of the National Coverage Determination Manual titled “Computed Tomography” (Pub. 100-3, 220.1). 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.
I have also attached the relative sections from the existing national coverage internet manual as a PDF below.
