SCAI Comments on Proposed Medicare Coverage Policies Restricting Invasive FFR Procedures

November 19, 2020—The Society for Cardiovascular Angiography and Interventions (SCAI) announced that it continues to oppose proposed local Medicare coverage policies that would restrict patient access to invasive fractional flow reserve (FFR) tests.

According to SCAI, Palmetto GBA, LLC of Columbia, South Carolina (covering North Carolina, South Carolina, Virginia, and West Virginia), finalized its policy without restrictions. SCAI is waiting for final coverage from Noridian Healthcare Solutions of Fargo, North Dakota (covering Alaska, Arizona, California, Guam, Hawaii, Idaho, Montana, Nevada, North Dakota, Northern Mariana Islands, Oregon, South Dakota, Utah, Washington, and Wyoming).

On November 18, SCAI President Cindy L. Grines, MD, and Lyndon Box, MD, Chair of the SCAI Government Relations Committee, filed comments (here) with CGS Medicare of Nashville, Tennessee (covering Kentucky and Ohio), objecting to proposed restrictions on FFR procedures. A similar letter (here) was sent to WPS Government Health Administrators of Madison, Wisconsin (covering Iowa, Kansas, Missouri, Nebraska, Indiana, and Michigan), on November 10.

The letters to CGS and WPS state, “SCAI believes that there is strong scientific evidence for the diagnostic performance of CT-FFR as a noninvasive screening tool. We object to the proposed restriction on coverage of both FFR-CT and invasive FFR procedures.” Additionally, the letters advise that invasive FFR is the most reliable way for accessing complex coronary disease during invasive angiography and the best way to accurately access serial lesions. Restrictions on the coverage of invasive FFR are “unnecessary and possibly deleterious to patient care,” concluded the SCAI letters.