Ongoing engagement by the American College of Radiology® (ACR®)’s Contractor Advisory Committee (CAC) network with Medicare Administrative Contractors (MACs) is resulting in expanded access to CT Perfusion (CTP) Analysis (CPT code 0042T). Physicians will now be reimbursed for CT Perfusion studies that include signs and symptoms for stroke patients even without positive findings.
As the College previously reported, MACs consistently denied coverage for CTP in cases where patients present with stroke-like symptoms but are later found to be negative for CT perfusion abnormalities consistent with a large vessel occlusion on imaging. This all changed when Palmetto GBA updated its local coverage policy effective June 2024. Currently, three of out seven MAC jurisdictions allow coverage, and ACR is working to expand these revisions from coast to coast.
MACs expanded coverage now includes Wisconsin Physicians Service Government Health Administrators (WPS) and National Government Services, Inc. (NGS) Medicare jurisdictions.
WPS released its updated Billing and Coding: Category III Codes article: A56902 to reflect the addition of many of the requested codes, effective Aug. 29. This policy is effective within jurisdictions servicing Iowa, Kansas, Missouri, Nebraska, Indiana and Michigan.
NGS released its updated Billing and Coding: Computed Tomography Cerebral Perfusion Analysis (CTP) – A58152 to reflect the addition of many of the requested ICD-10 CM codes for 0042T, effective Sept.15. This policy is effective within NGS's jurisdictions servicing Connecticut, Illinois, New Hampshire, New York, Maine, Massachusetts, Minnesota, Rhode Island, Vermont and Wisconsin.
Efforts continue to petition other MACs to make changes to their policies to reflect the inclusion of these diagnosis codes. Noridian Healthcare Solutions, LLC is currently considering the adoption of diagnosis codes presented by the CAC representatives. Providers should monitor all local coverage determination policies and updates using the Medicare Coverage Database; these policies ensure radiologists are appropriately reimbursed for medically reasonable and necessary services provided to Medicare patients.
If you have questions or want more information about local coverage policies and activities, visit the ACR CAC website, or contact Alicia Blakey, ACR Principal Economic Analyst.