Percutaneous Transluminal Angioplasty of Carotid Artery Concurrent with Stenting Proposed Decision Memo: July 2023
Published on
Wednesday, July 19, 2023
There are five covered indications in section B of National Coverage Determination (NCD) 20.7 Percutaneous Transluminal Angioplasty (PTA) for when PTA is covered.
In June 2022, the Multispecialty Carotid Alliance (MSCA) submitted a letter to CMS for reconsideration of covered indication B4 (concurrent with carotid stent placement in patients at high risk for carotid endarterectomy (CEA).
Last week, on July 11, 2023, CMS published Proposed Decision Memo CAG-00085R8: Percutaneous Transluminal Angioplasty (PTA) of the Carotid Artery Concurrent with Stenting. CMS notes, the scope of this reconsideration is limited to PTA concurrent with CAS including transcarotid artery revascularization (TCAR) procedures.
CMS summarizes that their proposals, which affect NCD 20.7 sections B4 and D, will revise Medicare coverage for PTA of the carotid arteries concurrent with stenting by:
- Expanding coverage to individuals previously only eligible for coverage in clinical trials.
- Expanding coverage to standard surgical risk individuals by removing the limitation of coverage to only high surgical risk individuals.
- Removing facility standards and approval requirements.
- Adding formal shared decision-making with the individual prior to furnishing CAS; and
- Allowing MAC discretion for all other coverage of PTA of the carotid artery concurrent with stenting not otherwise addressed in NCD 20.7.
CAS By the Numbers
|
CY 2022 PTA of Carotid Artery Concurrent with Stenting
Top 5 States by Volume & Overall Nationwide
|
|
Provider State
|
Claims Volume
|
Total Claims Payment
|
|
FL
|
1,250
|
$19,318,373.57
|
|
TX
|
1,158
|
$20,279,078.22
|
|
CA
|
1,007
|
$24,699,603.30
|
|
PA
|
541
|
$10,394,841.24
|
|
NY
|
523
|
$13,379,059.31
|
|
Nationwide
|
13,471
|
$246,555,039.68
|
|
Data Source: RealTime Medicare Data (RTMD) Medicare Fee-for-Service paid claims data for DOS CY 2022
|
Moving Forward
CMS is seeking comments on whether the shared decision-making interaction should require the use of a validated shared decision-making tool and/or if there are other options to achieve the goal of truly informed decision-making. The comment period is from July 11, 2023 through August 10, 2023.
Resources
NCD 20.7: https://www.cms.gov/medicare-coverage-database/view/ncd.aspx?NCDId=201
Proposed Decision Memo CAG-0085R8: https://www.cms.gov/medicare-coverage-database/view/ncacal-decision-memo.aspx?proposed=Y&ncaid=311&fromTracking=Y&
Article Author: Beth Cobb, RN, BSN, ACM, CCDS
Beth Cobb, RN, BSN, ACM, CCDS, is the Manager of Clinical Analytics at Medical Management Plus, Inc. Beth has over twenty-five years of experience in healthcare including eleven years in Case Management at a large multi-facility health system. In her current position, Beth is a principle writer for MMP’s Wednesday@One weekly e-newsletter, an active member of our HIPAA Compliance Committee, MMP’s Education Department Program Director and co-developer of MMP’s proprietary Compliance Protection Assessment Tool.
