HCFA likely to expandMedicare payment for MRA

HCFA bends to pressure from radiology community

Practitioners of MR angiography can look forward to expanded Medicarecoverage of the procedure, possibly as soon as early summer. TheHealth Care Financing Administration (HCFA) is reviewing recommendationsmade in March by its Technology Advisory Committee (TAC) to payfor MR angiograms of the carotids, if those angiograms deliverenough diagnostic confidence to forgo conventional x-ray angiography.

Current HCFA policy states that Medicare will pay only forMRAs of the head and neck when conventional angiography is contraindicated;for example, due to patient sensitivity to contrast media (SCAN3/13/96). But Steven Sheingold, HCFA director for technology andspecial analysis, said that the evidence presented during lastmonth's TAC meeting was strong enough that he expects a revisionof the Medicare policy along the lines of the committee's recommendations.

"We're looking at paying for MRA to the extent that itcan provide the diagnostic information necessary to go on to surgery,"Sheingold said. "Under that circumstance, we will probablybe willing to pay for it."

He emphasized, however, that the final decision has not yetbeen made.

"TAC makes the recommendations and provides discussion;HCFA staff make the decisions and implement them," he said.

Revision of the policy is likely, however, although such arevised policy will not take effect for at least two months. Duringthat time, HCFA staff will thoroughly review the recommendationsby TAC and form their own decision about expanded coverage. Anew policy must then be developed and disseminated.

"Part of the decision we have to make is how to writethe policy," Sheingold said. "We are really lookingto pay for MRA for the carotids, when it can be a replacementof conventional angiography. We will try to write the policy sothere are very limited circumstances under which we would payfor both conventional angiography and MRA."

Sheingold credits the American College of Radiology (ACR) withhelping to collect the evidence that made the case for MRA policyexpansion so persuasive.

"The package (of literature) ACR sent me saved my staffsome time in researching articles and actually obtaining them,"he said. "That was very helpful."

More good news about MRA coverage may be on the way later thisyear, Sheingold noted. Further expansion of the policy, beyondthe carotids to other parts of the body, will be considered atthe August TAC meeting.

"We're looking at one or two issues at a time, becausethis is such a fast-moving area, and it is very complex,"Sheingold said. "We will probably look at one or two otherindications at the August TAC meeting."