MLN Matters Number: MM6137
Related Change Request (CR) #: 6137
Related CR Release Date: July 11, 2008
Effective Date: May 12, 2008
Related CR Transmittal #: R87NCD
Implementation Date: August 11, 2008
Provider Types Affected
Physicians and providers who may wish to submit claims to Medicare Carriers, fiscal intermediaries (FIs) and Part A/B Medicare Administrative Contractors (A/B MACs) for PTA with stenting.
What Providers Need to Know
Be aware that the Centers for Medicare & Medicaid Services (CMS) has reviewed the evidence and on May 12, 2008 posted a final decision memorandum following reconsideration of its National Coverage Determination (NCD) on PTA with intracranial stent placement at section 20.7.B.5 of the Medicare NCD Manual. With CR 6137, CMS reaffirms its existing NCD with no changes, and will continue to cover PTA and stenting of intracranial arteries for the treatment of cerebral artery stenosis > 50 percent in patients with intracranial atherosclerotic disease when furnished in accordance with the Food and Drug Administration (FDA) approved protocols governing Category B Investigational Device Exemption (IDE) clinical trials. CMS will continue its national non-coverage for all other indications for PTA with or without stenting to treat obstructive lesions of the vertebral and cerebral arteries.
Background
This article is based on Change Request (CR) 6137, which responds to a request on August 24, 2007 by the manufacturer to reconsider and expand coverage to include Coverage with Evidence Development (CED) for intracranial stenting and angioplasty for patients in the IDE clinical trails.
Additional Information
You may see the official instruction (CR 6137) issued to your Medicare Carrier, FI, or A/B MAC, by going to
http://www.cms.hhs.gov/Transmittals/downloads/R87NCD.pdf. Section 20.7 of the Medicare NCD Manual is attached to CR 6137.
You may also review MM 5432 which preceded this article and provides the previous CMS response to PTA with stenting at
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5432.pdf.
If you have questions, please contact our Provider Contact Center at our toll free number, 1-888-828-2092.
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.