September 30, 2009
CMS is updating its national MRI coverage decision to give local contractors the discretion to cover MRI in blood flow measurement, but the agency will retain the current non-coverage of MRI for patients with cardiac pacemakers. The CMS summary follows, and the full decision is available on the CMS website.
CMS received a request to delete the national noncoverage of blood flow measurement from the Magnetic Resonance Imaging NCD at 220.2 of the NCD Manual and thus permit local Medicare contractor discretion to cover this use under 220.2(D). The requestor points to an apparent contradiction between this noncoverage provision and the national coverage of magnetic resonance imaging under the Magnetic Resonance Angiography NCD at 220.3 of the NCD Manual.
CMS also received a separate request to revise the reference to cardiac pacemakers to permit coverage for MRI when a beneficiary has an implanted device that has been designed, tested and FDA labeled for use in the MRI environment. NCD 220.2 currently includes the following:
The MRI is not covered when the following patient-specific contraindications are present. It is not covered for patients with cardiac pacemakers or with metallic clips on vascular aneurysms.
We have considered both requests in this reconsideration.
CMS finds that the blanket noncoverage of MRI for blood flow determination at 220.2 is no longer supported by the available evidence. Therefore we will remove the phrase "blood flow measurement," from the Nationally Noncovered Indications at 220.2(C)(2) of the National Coverage Determinations Manual. Pursuant to 220.2(D), local Medicare contractors will have discretion to cover (or not cover) this use.
CMS has not found evidence that MRI improves health outcomes in beneficiaries who have an implanted cardioverter-defibrillator or cardiac pacemaker approved by FDA for use in an MRI environment. We also note that there are currently no such devices. Therefore we will not change this provision of the NCD Manual. We will retain the current contraindications.
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