Washington, DC - Cardiologists, radiologists, and imaging companies are celebrating a decision by the US Centers for Medicare & Medicaid Services (CMS) to back down on its proposed national coverage determination on the use of cardiac computed tomography angiography (CTA) [1].

As previously reported by heartwire, all 50 individual US states already provide Medicare coverage for patients undergoing cardiac CTA under local coverage determinations, but the proposed federal policy decision would have limited Medicare coverage of a diagnostic CT to just two indications and only in cases where the patient was enrolled in a clinical trial of cardiac CT. The national policy decision, dubbed "coverage with evidence development," would have trumped all locally established coverage policies.

Wednesday, however, Dr Steve E Phurrough, director of the CMS Coverage and Analysis Group proposing the change, announced that the group had dropped its plan. "There is uncertainty regarding any potential health benefits or patient management alterations from including coronary CTA in the diagnostic workup of patients who may have CAD," Phurrough and colleagues write in their decision memo. "While public comments and specialty society opinions following the CMS proposed decision to use coverage with evidence development did not dispel the uncertainty of the test's clinical utility, they did strongly favor maintaining the local coverage policies for CTA. In light of this, CMS has decided to make no change in the current national coverage determination."

The decision memo notes that the CMS received 127 comments during the initial 30-day public-comment period, followed by 670 comments after the proposed determination was announced. Six professional societies—the American College of Cardiology, American Society of Nuclear Cardiology, American College of Radiology, Society for Cardiovascular Angiography and Interventions, North American Society for Cardiac Imaging, and the Society of Cardiovascular Computed Tomography (SCCT)—signed onto a statement expressing their disagreement with the proposed national determination and argued for keeping existing, locally determined coverage in place. Several organizations have now posted news of the decision, thanking their members for speaking out. The SCCT website also states that 79 members of the House of Representatives ultimately signed a letter to expressing their concerns about the CMS proposal, along with "almost a dozen" US senators who wrote to the CMS.

CTA researchers are applauding the decision. Dr Armin A Zadeh (Johns Hopkins University, Baltimore, MD) told heartwire, "In a time when evidence supporting the use of CTA is essentially exploding, I believe the CMS made a wise decision to allow more data to come in before this technology can be evaluated appropriately. I also agree with CMS's concern that there are insufficient data available currently in regard to long-term health benefits based on CTA results, but, as stated before, these studies are in progress and take time."

In the meantime, he said, "we should reserve CTA for indications that are endorsed by the American Heart Association and other professional societies. CTA is particularly useful to rule out obstructive coronary artery disease in patients with low to intermediate pretest probability, in whom cardiac catheterization is considered. In these cases, cardiac catheterization can frequently be avoided, reducing the risk of complications for the patient and reducing cost."