Medicare Compliance & Reimbursement

Physician practices that perform percutaneous transluminal angioplasty (PTA) with carotid stent placement have reason to celebrate.

The Centers for Medicare & Medicaid Services has decided to cover PTA with stent placement, as long as it's consistent with the Food and Drug Administration-approved stent device. The use must be part of an FDA-required post-approval study. CMS says it will consider the general question of whether Medicare should pay for all devices in FDA-required post-approval studies at a later date. CMS says about 20 percent of cerebral infarctions stem from obstructive lesions in the carotid arteries, and these infarctions cause 80 percent of strokes. PTA with stent placement shows promise in treating symptomatic carotid artery stenosis.

To be covered, patients must either have neurological symptoms and greater than 50 percent stenosis of the common or internal carotid artery by ultrasound or angiogram, or no neurological symptoms and greater than 80 percent stenosis. Also, patients must have a reference vessel diameter within the range of 4.0 mm and 9.0 mm at the target lesion.