CMS announces three national coverage decisions - Updata - Centers for Medicare and Medicaid Services - Brief Article

Healthcare Financial Management, Dec, 2001

The Centers for Medicare and Medicaid Services (CMS--formerly HCFA) announced three national coverage decisions (NCDs) on October 19, 2001. The NCDs will extend benefits to the following services:

* Ocular photodynamic therapy (OPT) with verteporfin;

* Ambulatory blood-pressure monitoring (ABPM); and

* Diabetic peripheral neuropathy with loss of protective sensation (LOPS).

OPT is used for the treatment of age-related macular degeneration (AMD), the nation's leading cause of blindness. OPT, which is used exclusively in patients with "wet" AMD (abnormal growth of blood vessels leading to leakage), involves the infusion of verteporfin followed by the use of a nonthermal laser. The laser causes the verteporfin to become active and begin treating adjacent lesions, resulting in the temporary closure of leaking blood vessels. CMS estimates that the new policy could affect up to 70,000 Medicare patients. Last year, CMS announced coverage of this therapy for patents with "classic" lesions. This decision extends the coverage to those with "occult" lesions. To read the NCD, go to http://www.hcfa.gov/coverage/8b3-ee.htm.> APBM is a method of taking blood pressure that involves having the patient wear a special cuff-like device for 24 hours. CMS believes that the cuff will lead to more accurate diagnoses by allowing physicians to better distinguish whether a patient's hypertension is a result of an office visit or some other malady. CMS rejected extended APBM coverage for four other conditions. To read the NCD, go to http://www.hcfa.gov/coverage/8b3-ff.htm.> Diabetic peripheral neuropathy with LOPS places an individual at risk for foot ulcers and amputations. The new policy allows beneficiaries with this condition to receive two preventive foot examinations annually. The decision is a departure from current Medicare policy, which generally excludes routine coverage of foot examinations. To read the NCD, go to http://www.hcfa.gov/coverage/8b3-o.htm.> CMS has not yet announced effective dates for these NCDs.

COPYRIGHT 2001 Healthcare Financial Management Association

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