Radiology Coding Alert

Question: I heard there was an update on Medicare's MRI coverage for patients with pacemakers. Where can I find the specific coverage document?

Nevada Subscriber

Answer: Nothing's final as of publication time, but CMS has posted a proposed decision memo (PDM) in favor of covering MRI scans for patients with MRI-safe pacemakers.

Following the pacemaker's FDA-approved labeling for MRI is the key. The PDM states that CMS "proposes that the evidence is adequate to conclude that magnetic resonance imaging (MRI) improves health outcomes for Medicare beneficiaries with implanted permanent pacemakers (PMs) when the PMs are used according to the FDA-approved labeling for use in an MRI environment. Therefore we propose that this use of MRI is reasonable and necessary under §1862(a)(1)(A) of the Social Security Act (the Act)."

What's next: If the PDM is finalized, expect a change tosection 220.2.C.1 of the National Coverage Determination (NCD) manual to match the new decision.

Stay focused: The PDM states that it relates to MRI coverage -- coverage of the Medtronic RevoMRI SureScan (FDAapproved as MRI safe) doesn't fall under the scope of the PDM.

Resources: The PDM is available online at www.cms.gov/medicare-coverage-database/details/nca-proposed-decisionmemo.aspx?NCAId=252&fromdb=true. Or you'll find a handy tool for finding national and local coverage documents at www.cms.gov/medicare-coverage-database/indexes/national-andlocal-indexes.aspx.