Just when you got excited about CT angiography (CTA) noninvasively diagnosing coronary artery disease, the Centers for Medicare and Medicaid Services (CMS) decided to slash reimbursement for CTA.
According to the CMS, "[t]he evidence is inadequate to conclude that cardiac computed tomographic angiography (CTA) is reasonable and necessary under section 1862(a)(1)(A) for the diagnosis of coronary artery disease (CAD)."
But wait, there is a silver lining. The CMS will reimburse for two CTA indications: for the diagnosis of CAD for symptomatic patients with chronic stable angina at intermediate risk of CAD; or symptomatic patients with unstable angina at a low risk of short-term death and intermediate risk of CAD. But this is only in cases where the patient is enrolled in a clinical trial for cardiac CT. Even patients who may have abnormal stress tests in low- or intermediate-risk populations are out of luck.
Many clinicians in the cardiac community argue that the CMS has not examined the full impact this proposal will have on the Medicare beneficiary, and have asked CMS to suspend its proposed National Coverage Decision (NCD) for two years to consider more studies published on coronary CTA.
Too late. Time's up. January 12, 2008 was the deadline to contribute to the CMS public comments forum. The final decision trumps all local coverage determinations for CTA already in place across all 50 states. Sorry asymptomatic patients - it's back to more costly and invasive procedures for you.