HCFA reschedules review of MRA reimbursement policy

New policy raised the ire of radiologists

The budget negotiations that snarled the U.S. government in Januaryalso caused the Health Care Financing Administration to postponeits technical advisory committee meeting from early February toMarch 26 and 27. While the meeting has been delayed, the agendaremains unchanged: to examine Medicare policy on MR angiographyand determine whether coverage might be expanded (SCAN 1/31/96).

HCFA, which runs the Medicare program, implemented a nationalpolicy beginning Oct. 1 to cover only head and neck indicationsof MRA, and only when the use of contrast media applied in conventionalx-ray angiography is contraindicated.

"Before we made that coverage decision, it was up to ourcontractors. Some were covering MRA, some were partially covering,and some were not covering it at all," said Steven Sheingold,HCFA director for technology and special analysis.

Although the ruling clarified Medicare coverage, it has raisedthe ire of radiologists who perform MRA. The problem is that somereferring physicians are routinely ordering MRAs for the headand neck, and they expect them to be performed, said David Davis,radiology chairman at George Washington University. Davis believesthat in these cases, radiology departments are probably eatingthe costs of MRA exams.

"I don't think very many places have taken the positionof telling patients that the service is not covered by Medicareand that they can sign a waiver and be charged. But that couldcome soon enough," Davis said.

The meeting of the technical advisory committee later thismonth could prevent that eventuality by loosening the restrictionson Medicare billing for MRA. Peer-reviewed articles submittedto HCFA by the American College of Radiology support such a move,said Davis, who chairs the ACR Commission on Neuroradiology andMRI.

Davis and his colleagues in the commission have been encouragingHCFA to change its new policy ever since it was released (SCAN10/25/95). HCFA's Sheingold believes a revision is likely, butwarns that Medicare policy probably will not extend coverage toparts of the body other than the head and neck. The more likelyoutcome of the meeting, he said, is a recommendation to allowcarriers to reimburse for MRA of the head and neck when it replaceseither x-ray angiography or Doppler ultrasound.