Medicare Administrative Contractors Seek Comments on CT Perfusion Proposed LCD

Currently, three out of seven Medicare Administrative Contractors (MACs) are seeking comments on the proposed local coverage determination (LCD) for Cerebral Perfusion Analysis. Physicians and subject matter experts have an opportunity to review the proposed LCD and submit comments to improve the clinical indications section and related ICD-10-CM diagnosis codes. The following coverage indications, limitations and/or medical necessity are under consideration:

• CT Perfusion (CTP), using automated post-processing software algorithmic analysis, is medically reasonable and necessary in patients with small acute ischemic stroke (AIS) caused by a unilateral large vessel occlusion (LVO) in the proximal anterior circulation evaluated at stroke centers. CTP can be used to aid in selection for endovascular mechanical thrombectomy (EVT) if one of the following other conditions is fulfilled:

1. Treatment (femoral puncture) can be started within 6–24 hours of the time last known to be at neurologic baseline and who meet the pre-CTP inclusion/exclusion criteria* as defined by the DAWN trial (1); or
2. Treatment (femoral puncture) can be started within 6–16 hours of the time last known to be at neurologic baseline and who meet the pre-CTP inclusion/exclusion criteria* as defined by the DEFUSE 3 trial (2).

*excluding criteria purely related to study mechanics (e.g., able to return for protocol required follow-up visits, etc.).

This is the first proposed LCD for this category III code, 0042T, cerebral perfusion analysis using computed tomography with contrast administration, including post-processing of parametric maps with determination of cerebral blood flow, cerebral blood volume and mean transit time, and there is an opportunity to make your voice heard. The American College of Radiology^® Contractor Advisory Committee (CAC) representatives will track this topic and submit written comments to the appropriate contractor. If your local MAC does not have an LCD on this topic and deems this as a non-covered service, a request should be sent to reverse this decision.

CAC representatives are vital to influence decisions related to reimbursement at the local level, but this cannot be done without the engagement of subject matter experts in neuroradiology. Neuroradiology is critical to providing the necessary evidence to improve this proposed coverage determination. The 2017 ACR-ASNR-SPR Practice Parameter for the Performance of Computed Tomography Perfusion in Neuroradiologic Imaging is listed as evidence to support coverage for this procedure.

MACs allow 45 days for the medical community to provide oral and/or written comments through open meetings and the public comment period. Interested parties (generally those that would be affected by the LCD, including providers, physicians, vendors, manufacturers, beneficiaries, caregivers, etc.) can make presentations of information and submit written comments related to the proposed LCD. All comments will be considered by the MAC before the LCD is finalized. If interested in submitting written comments, contact Alicia Blakey.

Comment Period Information

Proposed Local Coverage Determination (LCD): Computed Tomography Cerebral Perfusion Analysis (CTP)