CMS Updates ICD-10 Codes for Radiology NCDs
Change Request 14194 details ICD-10 coding revisions for mammograms, PET for oncologic conditions and percutaneous image-guided breast biopsy.
Read moreThe Centers for Medicare and Medicaid Services (CMS) recently released its final National Coverage Determination Reconsideration for Beta Amyloid Positron Emission Tomography in Dementia and Neurodegenerative Disease. The American College of Radiology® (ACR®) supports these final changes in coverage and hopes it will allow patients greater access to amyloid PET scans for Alzheimer’s disease diagnosis, management and evaluation of newly approved therapies.
CMS in July posted the proposed decision memorandum for public comment. The second public comment period ended Aug. 16, resulting in 90 submissions.
Most commenters supported CMS’ proposal to remove the current coverage with evidence development requirement and the limitation of one Beta Amyloid PET scan per patient. They either supported CMS’ proposal to remove the current National Coverage Decision (NCD), permitting Medicare coverage determinations for Beta Amyloid PET scan imaging to be made by Medicare Administrative Contractors (MACs), or expressed their desire for CMS to revise the current NCD — or at least work with the MACs to ensure that there would be consistent coverage of Beta Amyloid PET scan imaging if the NCD is removed.
CMS provides a detailed explanation of comments received and their rationale for finalizing the coverage determination. ACR members are encouraged to read the full coverage determination, including the public comment section of the final coverage decision.
Notable changes in Medicare coverage of Beta Amyloid PET scan in Dementia and Neurodegenerative Disease include:
CMS will instruct all MACs to reimburse claims retroactively to the date the final decision memoranda was released. A Change Request (CR) transmittal and an MLN Matters article will be released by CMS that provide instructions to providers and MACs about the implementation of the final NCD policy and updates the Medicare Claims Processing Manual. ACR will alert members as new information is released by CMS to implement this policy.
If you have questions about the final coverage decision or the NCD process, contact Alicia Blakey, ACR Principal Economic Policy Analyst.
CMS Updates ICD-10 Codes for Radiology NCDs
Change Request 14194 details ICD-10 coding revisions for mammograms, PET for oncologic conditions and percutaneous image-guided breast biopsy.
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