LCD Reference Article Response To Comments Article

Response to Comments: Computed Tomography Cerebral Perfusion Analysis (CTP)

A58398

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Document Note

Posted: 9/24/2020
Correction: A58398 is effective beginning 9/17/2020

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Source Article ID
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Article ID
A58398
Original ICD-9 Article ID
Not Applicable
Article Title
Response to Comments: Computed Tomography Cerebral Perfusion Analysis (CTP)
Article Type
Response to Comments
Original Effective Date
11/18/2020
Revision Effective Date
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Revision Ending Date
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Retirement Date
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CPT codes, descriptions, and other data only are copyright 2023 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.

Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

Current Dental Terminology © 2023 American Dental Association. All rights reserved.

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Article Text

This is a limited coverage policy for CTP (using automated post-processing software algorithmic analysis) for use in evaluation of patients with a stoke caused by unilateral large vessel occlusion to aid in selection for endovascular mechanical thrombectomy (EVT).

CGS Administrators, LLC received comments on proposed policy DL38694-Computed Tomography Cerebral Perfusion Analysis (CTP) from June 25, 2020 through August 9, 2020. Comments were received from the provider community. The notice period begins September 17, 2020 through November 1, 2020. The LCD becomes final on November 2, 2020.

Response To Comments

Number Comment Response
1

Comments received from Radiology Associates of Northern Kentucky with supporting references request the following changes:

  1. Allow any acute ischemic stroke (AIS), instead of a “small” acute ischemic stroke as currently proposed.

  1. Allow any patient suspected of AIS, and not just for AIS “caused by unilateral large vessel occlusion (LVO) in the proximal anterior circulation” as currently proposed.

  1. Allow treatment that is being considered in the 0-24 hour time period, instead of the “6-24” hour time period as currently proposed.
  2. Suggested correction of typographical error in background and rewording of DEFUSE 3 criteria win evidence section.
  3. Recommend expansion of ICD-10 list to include codes that represent all clinical signs and symptoms of possible stroke.

1. We will remove the word small based on recommendations and since there infarcts were not necessarily small in the DEFUSE 3 and DAWN studies.

2. While we understand the concerns of timely intervention for stroke management the current literature does not support the use of CTP as part of evaluation or screening stoke protocols. The existing evidence support the use of CTP to aid in selection for EVT. To be considered a candidate for EVT the patient must already have a known stoke and meet the criteria of the DAWN or DEFFUSE trail where clinical benefit has been demonstrated. The AHA/ASA guidelines do not endorse use of CPT outside of study protocols. While there are clinical trials that demonstrate the utility of CPT outside the specified window the data is still emerging. If future literature addresses the use of CTP as part of a screening or evaluation protocol this can be submitted as part of the LCD reconsideration process.

3. The policy allows treatment within 6-16 hours if using DEFUSE 3 criteria and 6-24 hours if using DAWN criteria. The two protocols have differences in selection criteria and is not known if the findings can be extrapolated outside the protocols. AHA/ASA cautions against use outside of the study protocols and therefore we will restrict to those protocols unless additional literature supports expansion.

4. Thank you for your correction and suggested wording these changes have been made.

5. See #2 above. The current limited coverage policy requires known stroke for coverage of CTP to aid in selection for EVT. Since this does not apply to screening or evaluation protocols the ICD-10 list will not be expanded.

 

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Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
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