Cardiology Coding Alert

Question: How should we interpret the new Medicare coverage decision for carotid artery stenting (CAS) with embolic protection?


Ohio Subscriber

Answer: The current coverage policy states that you have to comply with FDA guidelines and be enrolled in the post FDA approval data collection process, mentioned at www.cms.hhs.gov/mcd/viewdecisionmemo.asp?id=157.

The following in a summary of the Medicare coverage determination for those patients they consider CAS with embolism protection reasonably necessary:

1. Patients at high risk for carotid endarterectomy (CEA) and who also have symptomatic carotid artery stenosis > 70 percent. Medicare limits coverage to procedures performed using FDA-approved carotid artery stenting systems and embolic protection devices.

2. Patients at high risk for CEA and who have symptomatic carotid artery stenosis between 50 percent and 70 percent, in accordance with the Category B IDE clinical trials regulation (42 CFR 405.201), as a routine cost under the clinical trials policy (Medicare NCD Manual 310.1), or in accordance with the National Coverage Determination on CAS post-approval studies (Medicare NCD Manual 20.7).

3. Patients at high risk for CEA and who have asymptomatic carotid artery stenosis > 80 percent, in accordance with the Category B IDE clinical trials regulation (42 CFR 405.201), as a routine cost under the clinical trials policy(Medicare NCD Manual 310.1), or in accordance with the National Coverage Determination on CAS post-approval studies (Medicare NCD Manual 20.7).