Medicare grants limited coveragefor head and neck MR angiography

Feds to pay when x-ray angio is contraindicated

The Health Care Financing Administration last month expanded MedicarePart B coverage for magnetic resonance angiography of the heador neck in cases when x-ray angiography is contraindicated.

The new policy is consistent with a technology assessment publishedin October 1994 by the Agency for Health Care Policy and Research,according to Steven Sheingold, HCFA director of technology andspecial analysis staff (SCAN 7/19/95).

"We relied heavily on that assessment and the advice ofour medical staff," Sheingold said.

The assessment concluded that MRA has proved to be a good imagingtechnique for the carotid arteries, but it has yet to supplantangiography as the preferred preoperative technique, accordingto Sheingold.

"The judgment is that there won't be additional valuegained with MRA if x-ray angiography is going to be done beforesurgery anyway," he said.

There is good and bad news for the MRI community in the newpolicy. In granting reimbursement, HCFA tacitly recognized themedical efficacy of head and neck MRA. Medicare reimbursementis widely interpreted as the final step in gaining coverage fromnearly all private payors.

At the same time, regional carriers, who had been somewhatfree in granting MRA payment, are obligated to withdraw coveragefor clinical conditions not specified in HCFA's instructions.Medicare insurance carrier Aetna, for example, informed its Washingtonstate providers in September that the payment status for MRA ofthe chest, spinal canal, pelvis, abdomen and extremities has changedfrom "active" to "not covered."

"For some of our carriers, this will be a restrictionin coverage. For other carriers, it will actually be an expansionof coverage because they weren't covering it at all," Sheingoldsaid.

Professional and technical relative values for head and neckMRA have been added to the Medicare Part B fee schedules. Therates are subject to geographic variation, but Medicare will typicallypay about $375 for the technical component of head and neck MRA,according to Sheingold. Payment for the professional componentwill be about $75.

The federal policy does not define when conventional catheterangiography is inappropriate because of contraindications dueto contrast media. Those standards are to be defined by the health-carefacility or physician, Sheingold said.

The policy does not affect payment for Medicare beneficiarieswho undergo MRA during hospital stays. Inpatient procedures arereimbursed according to a flat rate governed by the Medicare diagnosis-relatedgroup (DRG) system.