MLN Matters Number: MM6098
Related Change Request (CR) #: 6098
Related CR Release Date: June 27, 2008
Effective Date: March 12, 2008
Related CR Transmittal #: R85NCD
Implementation Date: July 28, 2008
Provider Types Affected
Physicians, providers, and suppliers submitting claims to Medicare contractors (carriers, Fiscal Intermediaries (FIs), and/or Part A/B Medicare Administrative Contractors (A/B MACs)) for Cardiac CTA services provided to Medicare beneficiaries.
Provider Action Needed
This article is informational only and based on Change Request (CR) 6098 which announces that the Centers for Medicare & Medicaid Services (CMS), upon review of the available evidence, has determined that the coverage of cardiac computed tomographic angiography (CTA) to diagnosis coronary artery disease (CAD) will remain at local Medicare contractor discretion, and no national coverage determination (NCD) is appropriate at this time.
Background
CTA is a noninvasive method (using intravenous contrast) to visualize the coronary arteries (or other vessels) using high resolution, high speed computed tomography (CT).
After examining the medical evidence, CMS has determined that no NCD is appropriate at this time, effective March 12, 2008. Pursuant to the Social Security Act (Section 862(a)(1)(A)), decisions should be made by local contractors through:
- the local coverage determination process, or
- case-by-case adjudication.
Therefore, all claims for CTA used to diagnose CAD will continue to be determined by local Medicare contractor discretion and section 220.1 of Publication 100-03 of the NCD Manual remains unchanged.
Additional Information
The official instruction, CR 6098, issued to your carrier, FI, and A/B MAC regarding this change may be viewed at
http://www.cms.hhs.gov/Transmittals/downloads/R85NCD.pdf.
If you have any questions, please contact our Provider Contact Center at our toll free number, 1-866-332-7025.
Disclaimer
This article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statement of their contents.