Medicare Coverage Update for MRI

on Wednesday, 18 November 2009. All News Items

Change Request (CR) 6672 (Transmittal 1831 and Transmittal 107) updated the National Coverage Determination (NCD) for MRI by removing blood flow measurement as a nationally non-covered indication for MRI.  This CR is effective September 28, 2009 with an implementation date of January 4, 2010.  The CR gives local Medicare contractors the discretion to cover or not to cover MRI for blood flow measurement.  In November, Cahaba GBA published an update of their Local Coverage Determinations (LCDs) for MRI of the Brain and MRI of the Spine to allow coverage for blood flow measurement if all other requirements of the LCD are met.  Effective September 28, 2009, the ‘Limitations’ sections of these LCDs were revised to remove the reference to the use of MRI for blood flow measurement as investigational.

Also as part of the NCD update, the following 4 CPT codes will be changed from non-covered to covered, and will appear in the January 2010 Integrated Outpatient Code Editor (IOCE) Quarterly Updates:

  • 75558, Cardiac MRI for morphology/function w/o contrast materials; w/flow/velocity quantification
  • 75560, Cardiac MRI for morphology/function w/o contrast materials; w/flow/velocity quantification & stress
  • 75562, Cardiac MRI for morphology/function w/o contrast materials; followed by contrast materials/further sequences, w/flow/velocity quantification
  • 75564, Cardiac MRI for morphology/function w/o contrast materials; followed by contrast materials/further sequences, w/flow/velocity quantification & stress.

Note that all other uses of MRI under the NCD remain unchanged, including non-coverage of imaging of cortical bone and calcifications, procedures involving spatial resolution of bone and calcifications, for patients with FDA-approved (for an MRI environment) implanted cardioverter-defibrillators or cardiac pacemakers, or for patients with metallic clips on vascular aneurysms.

For more information see the MLN Matters Article MM6672 and the Cahaba Notice MRI Brain Spine .

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