CMS National Coverage Determination for Microvolt T-Wave Alternans™ Testing Using the Analytic Spectral Method®

Using the Analytic Spectral Method®

On March 21, 2006, the Centers for Medicare and Medicaid Services (CMS) issued a decision memo stating...

“Microvolt T-Wave Alternans diagnostic testing is covered for the evaluation of patients at risk for sudden cardiac death, only when the spectral analytic method is used.”

Read the complete decision memo.

Who should be tested?

Per the NCD, MTWA testing is reasonable and necessary for the evaluation of Medicare patients at risk of sudden cardiac death (SCD).

Who are the patients at risk?

• Previous heart attack victims

50-75% of people who die from SCD have suffered a previous infarct.

• Coronary artery disease

80% of SCD victims have signs and/or symptoms of coronary artery disease (CAD).

• Heart failure

In people diagnosed with heart failure, sudden cardiac death occurs at 6-9 times the rate of the general population.

• LV dysfunction

Reduced left ventricular ejection fraction (LVEF) is one of the most significant risk factors for overall mortality and sudden cardiac death.

• Unexplained syncope

Although syncope is usually benign, it may be a symptom of serious cardiac disease and can predispose individuals to sudden death.

How is Medicare billed for the MTWA Test?

• Use CPT Code -93025

Microvolt T-Wave Alternans for assessment of ventricular arrhythmias

• Use ICD-9-CM Diagnosis Codes

For a listing of recommended ICD-9-CM Diagnosis codes typically associated with risk of sudden cardiac death that support MTWA testing click here.

How much does Medicare pay for the MTWA test?

• The 2010 national average for MTWA testing (CPT Code 93025) is $196.71. Actual reimbursement varies by geographical region