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Issue 2006-05, May 2006
MLN Matters. . .Information for Medicare Providers
(Issued by the Centers for Medicare & Medicaid Services)
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Microvolt T-wave Alternans (MTWA) Diagnostic Testing
Provider Types Affected
Physicians, suppliers, and providers billing Medicare carriers and/or fiscal intermediaries (FIs) for MTWA diagnostic testing services
Provider Action Needed
This article is based on Change Request (CR) 4351, which announces that effective for dates of service on or after March 21, 2006, MTWA diagnostic testing is covered for the evaluation of patients at risk of sudden cardiac death (SCD), only when the spectral analysis method is used.
Background
MTWA testing is a noninvasive diagnostic test that detects minute electrical activity in a portion of the electrocardiogram (EKG) known as the T-wave. The test is performed by placing highly sensitive electrodes on a patient’s chest prior to a period of controlled exercise.
These electrodes detect very small beat-to-beat voltage fluctuations (on the order of one-millionth of volt) in the EKG T-wave. Spectral analysis (a sensitive mathematical method of measuring and comparing time and the EKG signals) is then used to calculate these minute voltage changes. Computer software then analyzes these microvolt changes and produces a report to be interpreted by a physician.
Within patient groups that may be considered candidates for Implantable Cardioverter Defibrillator (ICD) therapy, published literature indicates that a negative MTWA test may be useful in identifying low-risk patients who are unlikely to benefit from, and who may experience worse outcomes from, ICD placement.
Effective for services performed on or after March 21, 2006, the following Current Procedural Terminology (CPT) code will be recognized as nationally payable for MTWA diagnostic testing.
MLN Matters Number: MM4351 Related Change Request Number: 4351
| CPT Code |
Descriptor |
93025 |
MTWA for assessment of ventricular arrhythmias |
This is a national coverage determination (NCD) made under section 1862(a)(1) of the Social Security Act (the Act). NCDs are binding on all carriers, FIs, quality improvement organizations, health maintenance organizations, competitive medical plans, health care prepayment plans, the Medicare Appeals Council, and administrative law judges (ALJ) (see 42 CFR section 405.1064, effective May 1, 2005).
An NCD that expands coverage is also binding on a Medicare Advantage Organization. In addition, an ALJ may not review an NCD. (See section 1869(f)(1)(A)(i) of the Act.)
Notes: MTWA diagnostic testing is noncovered for the evaluation of patients at risk for SCD if measurement is not performed employing the spectral analysis method.
Prior to March 21, 2006, MTWA diagnostic testing was covered at local carrier/FI discretion. Carrier/FI discretion is no longer applicable. |
Implementation
The implementation date for the instruction is April 3, 2006.
Additional Information
For complete details, please see the official instruction (CR4351) issued to your carrier/FI regarding this change. There are two parts to CR4351, transmittal R894CP, which includes the Medicare claims processing instructions at http://www.cms.hhs.gov/Transmittals/downloads/R894CP.pdf  and transmittal R49NCD, which includes the National Coverage Determination Manual revision at http://www.cms.hhs.gov/Transmittals/downloads/R49NCD.pdf on the CMS Web site.
If you have questions, please contact your carrier/FI at their toll-free number, which may be found at http://www.cms.hhs.gov/apps/contacts/  on the CMS Web site.
Disclaimer
This article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statement of their contents.
MLN Matters Number: MM4351
Pub. 100-4, Transmittal# R894CP, CR# 4351
Pub. 100-3, Transmittal# R49NCD, CR# 4351
Related CR Release Date: March 24, 2006
Effective Date: March 21, 2006
Implementation Date: April 3, 2006
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