SCMR Advocacy Addressing CMR Coverage

Improved Coverage Policy for CMR Services

In a positive step forward for patients and the field of cardiovascular magnetic resonance (CMR), Aetna, one of America’s largest US-American health insurance companies covering more than 23 million lives, updated their coverage policy for CMR services. The recommendations now also include coverage of CMR for the detection of coronary artery disease, specifically:  The detection and localization of inducible myocardial perfusion deficits or inducible contractile dysfunction; detection or quantification of the extent of acute or chronic myocardial infarction; differentiation of recent from remote myocardial infarction; and demonstration of complications from infarction.  The new policy also strengthens coverage to evaluate non-ischemic cardiomyopathies.  To view the new Aetna CMR policy, effective as of mid-July 2017, visit their website.

CMS Considers MRI Coverage

The ACC, along with SCMR, submitted the attached comments to the Centers for Medicare and Medicaid Services (CMS), asking the agency to consider the value of MRIs for certain cardiovascular indications as it reconsiders its MRI coverage policies.

The ACC/SCMR letter highlights recent documents that address the management of patients with implantable cardiac devices who would benefit from MRI. “We encourage CMS to rely upon this document to find a coverage framework that allows physicians and their patients to have a conversation to evaluate the risks and benefits of imaging options and decide the best path forward for that patient without worry that their imaging may not be covered because of the patient’s implantable device,” said ACC President Mary Norine Walsh, MD, FACC, and SCMR President Matthias G. Friedrich, MD, FACC.

CMS must issue a proposed coverage decision by Jan. 12, 2018, but this could come sooner. Stakeholders will again have a 30-day comment period to offer feedback at that time. The current MRI coverage policy was last reviewed in 2011 when CMS added coverage for patients with pacemakers when used according to U.S. Food and Drug Administration-approved labeling in an MRI environment or in a clinical study.

The SCMR is actively engaged in informing payers to support appropriate coverage of CMR services.  We are monitoring review cycles for payer policies on CMR and endeavor to provide comments to major national payers. In this ongoing effort, we ask all SCMR members to be our eyes and ears on the ground. Please tell us about inappropriately denied coverage for CMR services by local payers.  We will provide guidance and tools to help you successfully negotiate for adequate reimbursement. Please contact SCMR Headquarters for more information.

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