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Home > Medical Professionals > Health Policy and Government Relations > Regulatory Issues > Final Decision - CMS Coverage for Carotid Stenting

Final Decision On CMS Coverage For Carotid Stenting

On April 30, 2007 the CMS Coverage and Analysis Group posted their Final Decision for the year regarding Medicare coverage for Carotid stenting with embolic protection.

In brief, CMS decided to:

1) Retract their proposed expansion of CAS coverage that would have included  asymptomatic high-surgical-risk carotid patients

2) Retract their proposal to exclude octogenarians from CAS coverage

3) Retract their proposal to require a surgical consultation to determine if a patient would be considered "high-risk" for carotid endarterectomy

4) Refine their requirements for CAS facility recertification

5) Reiterate and confirm their decision to cover CAS only when used in combination with distal embolic protection.

Therefore, until further notice, routine Medicare coverage for CAS with embolic protection will be limited  to symptomatic patients who would be considered high-surgical-risk for CEA, and who have an angiographically proven 70% or worse carotid stenosis.
 
Patients who are at high risk for CEA and have asymptomatic carotid artery stenosis of 80% or worse will be covered if performed within certain Category B IDE clinical trials or in accordance with certain CAS post approval studies. 
 
Patients who are at high risk or CEA and have symptomatic carotid artery stenosis between 50% and 70% will be covered if performed within certain  Category B IDE clinical trials or in accordance with certain CAS post approval studies.

Go to CMS site for details