HCFA readies MRA reimbursement policy

Policy makers at the Health Care Financing Administration havefinalized a national coverage policy for MR angiography that willsoon be published in one of the agency's coverage issues manuals,a HCFA official confirmed late last month.

HCFA officials aren't saying exactly when the national coveragepolicy will be published or what it will entail. But for manyfrustrated radiologists and business managers, any uniform standardwould be a welcome relief from the existing carrier-based standard,in which HCFA has authorized individual carriers to formulatetheir own criteria for MRA reimbursement.

Officially, coverage policy at HCFA is determined by a lengthyreview of published literature, which in the case of MRA includesa 1994 technology assessment document from the Agency for HealthCare Policy and Research. The AHCPR concluded that MRA has demonstrateddiagnostic accuracy in the head and neck, abdomen and thorax.The report deemed the technology still investigational for evaluationof coronary artery disease and peripheral vasculature.

Payors' perceptions of MRA suffer from a shortage of currentdata reflecting the technology's maturity, according to Dr. KentYucel, director of angiography and MRI at Boston University MedicalCenter.

MRA could be considered experimental in coronary or pulmonaryartery applications, Yucel said. But it is definitely not experimentalfor imaging the aorta, peripheral vasculature, intracranial arteries,carotids, infrarenal arteries, or for venography, he said.

Demonstrating that MRA is no longer experimental, however,is only half the battle over reimbursement dollars. Payors whowould reimburse for MRA as a less expensive replacement for conventionalangiography are reluctant to pay for both procedures.