Cardiac MRI May Be Covered, May Not

The Centers for Medicare & Medicaid Services (CMS) has determined that its blanket of non-coverage for blood flow measurement using magnetic resonance imaging (MRI) technology contradicts its policies and magnetic resonance angiography (MRA). CMS has eliminated that from the national coverage determination (NCD), effective Sept. 28, and is allowing payers to choose to cover the services.  This will impact four codes in January’s outpatient code editor (OCE).

The 2009 codes which are changing from non-covered to covered and will appear in the January 2010 OCE are as follows:

75558

Cardiac magnetic resonance imaging for morphology and function without contrast material; with flow/velocity quantification

75560

Cardiac magnetic resonance imaging for morphology and function without contrast material; with flow/velocity quantification and stress

75562

Cardiac magnetic resonance imaging for morphology and function without contrast material(s), followed by contrast material(s) and further sequences; with flow/velocity quantification

75564

Cardiac magnetic resonance imaging for morphology and function without contrast material(s), followed by contrast material(s) and further sequences; with flow/velocity quantification and stress

 






 


Note: Your Medicare contractor will not search for previously-processed claims with service dates of Sept. 28 through Dec. 31, but will adjust any claims that you bring to their attention.

All other uses of  MRI noted in Pub. 100-03, NCD Manual, section 220.2 remain unchanged. If you would like to know more, check out CMS transmittal 107, issued Oct. 16.

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