Radiology societies fight Medicare Administrative Contractor’s proposed coverage restriction
Two radiology societies are fighting one Medicare Administrative Contractor’s proposal to restrict coverage for a key image-guided procedure.
National Government Services is seeking to limit the use of thermal destruction of the intraosseous basivertebral nerve or BVN. Commonly known as the “Intracept procedure,” the FDA-cleared approach used ablation to help treat chronic lower back pain.
However, NGS is proposing to restrict coverage only to those who meet several criteria. These include chronic pain lasting longer than six months, documented failure to respond to nonsurgical management and MRI evidence supporting the need for BVN.
The American College of Radiology and Society of Interventional Radiology are challenging these restrictions. They’re asking the MAC to modify its proposal to avoid blocking patients from receiving this critical treatment.
“The Society of Interventional Radiology respectfully recommends that the [local coverage determination] be revised to emphasize patient-centered, evidence-based care, allow individualized clinical decision-making and focus on functional outcomes rather than rigid, prescriptive requirements,” ACR and SIR wrote on Feb. 27. “These changes would ensure Medicare beneficiaries have timely access to safe and effective [BVN ablation].”
SIR highlighted the issue in a recent news update to members. The society said it is seeking changes including reducing “overly prescriptive conservative care requirements,” eliminating “unsupported exclusions” and preserving individual clinical decision-making. It noted that BVN is supported by level 1 evidence, and coverage policy should “accurately reflect the strength of the data while safeguarding appropriate patient access.”
If finalized, the decision would impact radiology providers across Illinois, Minnesota, Wisconsin, Connecticut, New York, Maine, Massachusetts, New Hampshire, Rhode Island and Vermont. NGS also recently proposed denying coverage for a key AI-based brain MRI technology.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.