MEDICARE SAYS WILL STILL PAY FOR HEART SCANS TO LOOK FOR BLOOD VESSEL BLOCKAGE ELECTRON BEAM CT SCANS OF THE HEART FOR CORONARY ARTERY DISEASE

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Ultra fast or CT Scan of heart is a non invasive test for blood vessel blockage



Medicare has decided to continue to pay for a non invasive test for heart problems called a CT heart scan or ultra fast CT or electron beam CT scan for calcium in the arteries (blood vessels) of people who have symptoms of heart disease. You have probably heard of heart scans or Ultra fast CT because they are advertised heavily. Heart scans or heart CT scans or electron beam CT is touted as a non invasive way to look for heart disease and chances of a heart attack. Doctors would like to find a non invasive test to detect and predict heart disease and who is going to have a heart attack.






What are coronary arteries and why they are so important?



Coronary arteries are the blood vessels that supply the heart itself. If a coronary artery is blocked so that blood doesn't flow to a part of the heart it causes a heart attack. One of the most informative heart tests to look for blocked coronary arteries in the heart is a coronary angiogram. But a coronary angiogram involves inserting a catheter into the blood vessels and has some risks. Generally an angiogram is recommended when there are indications of blocked heart arteries. So for example, when David Letterman had chest pains his doctors wanted him to get an angiogram to look for blockage. A non invasive test for coronary artery blockage would encourage more people to get tested.








What is a calcium score on a heart scan?


Heart scans or heart CT scans or electron beam CT provide pictures of the coronary arteries and calcium in them. Calcium deposits show up as bright white spots on the scan. The standard imaging technique for coronary arteries uses electron beam computerized tomography (EBCT, also called ultra-fast CT). The theory is that the amount of calcium in the coronary arteries can help predict whether a person is at risk for a heart attack and has coronary artery disease or blockage. The result of the heart scan is a coronary calcium score . "A number of studies have reported that coronary artery calcium has independent and incremental value when added to clinical or historical data in the estimation of death and nonfatal heart attack (myocardial infarction)."




Computed tomographic angiography is a general phrase used to describe noninvasive imaging of the arteries with various types of computed tomography (CT) machines, such as multislice CT, multidetector CT, and dual source CT.The use of CT scans has increased over the years due to advances in the technology and rapid diffusion of the machines outside the hospital settings. The initial single slice CT machines produced poor quality images. In the late 1990’s, 4 slice CT machines were introduced, with 16 slice and 64 slice CT machines following shortly afterwards. Image quality and performance reportedly increased with each model. However, questions remain on the indications for use.



A particular focus has been the use of computed tomographic angiography for evaluation of the coronary arteries in patients with chest pain. Proponents have claimed that cardiac or coronary CTA may reduce the need for invasive coronary angiography for certain patients. Critics have pointed out the lack of evidence on outcomes and the limitations to the technology including uninterpretable segments and the health risks from the considerable radiation exposure. Although there are other uses of CT, Medicare's decision focuses only on the use of CT for the evaluation of the coronary arteries in patients with symptomatic coronary artery disease like chest pain. Imaging performed on patients without chest pain (asymptomatic patients) would be considered screening and is not an available benefit in the Medicare program.

Decision Memo for Computed Tomographic Angiography (CAG-00385N)