CMS Decision Memorandum

Vascular Registry is endorsed by:
Society of Interventional Radiology

 


 

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. (see CMS Final Decision) 

Facilities must do the following to receive payment:

  1. Submit a letter of intent to be credentialed as a CMS-approved carotid stenting facility and receive formal CMS approval. 
  2. Collect data on all carotid artery stenting procedures done at that particular facility. Data must be analyzed every six months (or more frequently) to ensure patient safety. These data will be used in the process of re-credentialing the facility.

To help you and your facility comply with these reimbursement criteria, SVS has developed a Sample Letter of Intent and Vascular Registry.

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.

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