Radiology groups slam MAC’s local coverage determination, claiming its irrational, lacks evidence

Radiology groups are slamming a Medicare Administrative Contractor’s recent local coverage determination for one key pain treatment approach, claiming its irrational and unsupported by scientific evidence.

Noridian Healthcare Solutions recently announced the proposal, which pertains to an interventional surgical procedure used to treat chronic lower back pain emanating from the vertebrae. The MAC is proposing to exclude coverage for this nerve ablation procedure if the patient has any nonvertebral pathology that could contribute to their symptoms.

The American Society of Neuroradiology and others are expressing “significant concern” around this restriction. A second change also would require patients to undergo screening, evaluation and diagnosis by a multidisciplinary team that includes a psychologist prior to undergoing the interventional procedure.

“Neither of these requirements is rational or evidence-based,” ASNR, the American College of Radiology, the American Society of Spine Radiology and the Society of Interventional Radiology wrote to Noridian, which covers Jurisdiction E including California, Hawaii and Nevada. “The studies, appropriately cited by the [local coverage determination], that have demonstrated the procedure’s effectiveness did not preclude the treatment of patients with nonvertebral pathology that could contribute to symptoms or complaints, nor did they require extensive screening, evaluation, and diagnosis by a multidisciplinary team and implementation of a psychological assessment.

The radiology groups are “strongly” suggesting that the MAC revise the language in its proposal. This would ensure that the patient’s pain is most likely vertebrogenic in nature, so if imaging findings suggest otherwise, providers can consider other more appropriate treatments. ASNR et al. also asked Noridian to quash any mentions of psychological evaluations for patients requiring such intraosseous basivertebral nerve ablation treatments.

“Requiring screening, evaluation and diagnosis by a multidisciplinary team is not reasonable and serves only as a barrier to treatment,” the societies wrote. “A psychological assessment in these patients is unnecessary as these patients have chronic pain (>6 months); have already undergone extensive conservative, nonsurgical management; and have Type 1 or Type 2 Modic changes on MRI. For this patient population, the treatment is highly effective. There simply is no basis for a psychological assessment in these patients.”

You can read the full letter here and the local coverage determination from the Medicare Administrative Contractor here.