HCFA committee to meet in Februaryto review policy on MRA payments

January 31, 1996

Earlier rules resulted in shrinking coverageThe Health Care Financing Administration plans to review its MRangiography policy when the agency holds its next technology advisorycommittee meeting on Feb. 6 and 7. The review of this policy,which

Earlier rules resulted in shrinking coverage

The Health Care Financing Administration plans to review its MRangiography policy when the agency holds its next technology advisorycommittee meeting on Feb. 6 and 7. The review of this policy,which was instituted less than six months ago, was prompted bythe recognition that a substantial amount of clinical data wasnot factored into the initial decision-making process (SCAN 10/25/95).

"We view policy as being much more flexible than we havein the past," said Steven Sheingold, director for technologyand special analysis at HCFA. "We have been working withthe American College of Radiology and others and we know thatthere has been a considerable amount of literature published in1994 and 1995. We will be reviewing these data for the head andneck and it is possible that a recommendation for a change inpolicy for the head and neck could occur as soon as February orMarch."

The policy now in effect was developed on the basis of a 1994analysis by the Office of Healthcare Technology Assessment. Sheingoldhas found a number of peer-reviewed studies published since thenthat support the use of head and neck MRA in circumstances beyondthose covered by HCFA policy.

The current policy has caused many Medicare insurance carriersto pull back their coverage for MRA. In the absence of a nationalpolicy, carriers are given latitude to make their own decisionsabout covering the use of new technologies or applications, Sheingoldexplained. Because of this, many Medicare contractors were payingfor all MR angiograms of the head and neck before the HCFA ruleswere released in September. Some were even covering angiogramsfor all MR codes, Sheingold said.

But when HCFA released its national policy, which allows paymentonly for head and neck exams on patients who are contraindicatedfor the use of contrast media applied in conventional x-ray angiography,carriers were obligated to go along with the new rule.

HCFA constrained MRA payment because the agency does not wantto pay for MRA in addition to other, traditional exams.

"It was the general assessment at the time (the originalpolicy was formed) that surgeons would still require conventionalangiography, so what we would probably be paying for is firstan ultrasound, then an MRA and then conventional angiography --and that is what we are trying to avoid," Sheingold said.

Sheingold is leaning toward a policy that would pay for conventionalangiography following MRA, but only if there is a considerabledifference between the ultrasound and an MR angiogram. The datato be presented at the February meeting will show that ultrasoundand MRA agree between 87% and 90% of the time, he said.

MRA is attractive to HCFA for two reasons, Sheingold noted.

"It is less costly for us (compared to conventional angiography)and we don't ignore the (potential of eliminating) the risk tothe patient from conventional angiography," he said.