In a campaign to educate Medicare Administrative Contractors (MACs) led by SCAI Government Relations Committee Co-Chair Dr. Joaquin Cigarroa, SCAI successfully worked to submit written comments, provide oral testimony, and hold private meetings with several contractor Medical Directors.

Three of the nation’s influential MACs had proposed restrictions on the use of invasive FFR when FFRct is performed first in a series of proposed local coverage decisions (LCDs). The three MACs: CGS, Noridian, and WPS, perform insurance carrier type business in 25 States and U.S. Territories. That restriction has been removed from all three final coverage decisions.

The three final LCDs are:

  • Noridian Final LCD (Alaska, American Samoa, Arizona, California, Guam, Hawaii, Idaho, Montana, Nevada, North Dakota, Northern Mariana Islands, Oregon, South Dakota, Utah, Washington, and Wyoming)
  • WPS Final LCD (Indiana, Iowa, Kansas, Michigan, Missouri, and Nebraska)

Medicare’s other administrative contractors are likely to come to similar conclusions. Noridian stated:

“As this policy matured into a collaborative effort with other contractors, these responses incorporate major themes presented to other contractors as well. Comments received by Noridian will be archived with the policy.”

One MAC publicly stated:

“We especially thank the Society for Cardiovascular Angiography and Interventions, … for responses coordinated on behalf of their membership.”

They went on to say:

“We recognize that FFRct is a valuable tool but does not have equivalency of invasive FFR. We understand there are rare but notable circumstances where the FFRct may not be accurate and confirmation with invasive FFR is needed. In addition, there are false positives FFRct cases in which case invasive FFR may prevent unnecessary stenting, or to assess for residual ischemia after stenting.”

The SCAI Government Relations Committee and staff will continue to monitor these and other LCDs in the future. It is critical that MAC coverage decisions continue to be reviewed by interventional cardiologists and other clinicians to ensure patients receive the care they deserve.