CMS OKs MRI blood-flow coverage

Jul 1, 2009

The U.S. Centers for Medicare and Medicaid Services (CMS) has decided to extend coverage to the use of MRI for blood-flow management scans.

In a June 30 ruling, CMS found that the "blanket noncoverage of MRI for blood flow determination ... is no longer supported by the available evidence. Therefore we propose to remove the phrase 'blood flow measurement,' from the Nationally Noncovered Indications at 220.2(C)(2) of the National Coverage Determinations Manual."

The ruling adds that local Medicare insurers will have the choice of whether to reimburse for the imaging procedure.

The decision is a win for a coalition of cardiac imaging groups that requested the change in January, asserting that a substantial body of evidence has accumulated since 1985 that demonstrates the utility of MRI-based flow analysis. The group includes the American College of Radiology (ACR), the American College of Cardiology (ACC), the North American Society for Cardiac Imaging (NASCI), and the Society for Cardiovascular Magnetic Resonance (SCMR).

CMS also considered a separate request to revise a reference to cardiac pacemakers to permit coverage for MRI when a beneficiary has an implanted device that has been designed, tested, and labeled by the U.S. Food and Drug Administration (FDA) for use in the MRI environment.

The agency, however, said that it found no evidence that MRI improves health outcomes in patients who have an implanted cardioverter-defibrillator or cardiac pacemaker approved by the FDA for MRI use.

CMS noted that there are currently no such devices on the market, so it proposed no change in the current provision and will retain the current contraindications.

CMS makes no change to coronary CTA payments, March 12, 2008

CMS proposes hike in cardiac PET reimbursement, October 19, 2007

Cardiac MR measures predict pulmonary hypertension, April 9, 2007

MR angiography offers greater detail in vascular imaging, March 10, 2006