National Coverage Analysis (NCA) Tracking Sheet

Multiple-Seizure Electroconvulsive Therapy

CAG-00134N

Issue

Electroconvulsive therapy (ECT) is a treatment for severe mental illness in which a brief application of electric stimulus is used to produce a generalized seizure. In multiple monitored electroconvulsive therapy (MMECT) a patient undergoes ECT in the usual fashion, but before gaining consciousness, undergoes another session of ECT designed to elicit a second (or additional) seizure.

A report issued by the Office of the Inspector General (OIG) in December 2001 states "Recent objective reviews have suggested that MMECT should not be part of a routine clinical treatment." However, claim data obtained by the OIG describes use of MMECT at a rate that exceeds what would be expected for a test that should only be used rarely.

CMS will review the scientific evidence and determine if the literature supports the OIG's findings and to what extent, if any, MMECT should be covered under Medicare.

Benefit Category

Physicians' Services

Requestor Information

Requestor Name Requestor Letter
Internally generated following the OIG's report. N/A
N/A

Important Dates

Formal Request Accepted and Review Initiated
04/22/2002
Expected NCA Completion Date
11/19/2002
Public Comment Period
05/22/2002 - 06/21/2002
Proposed Decision Memo Due Date
Proposed Decision Memo Released
Proposed Decision Memo Public Comment Period
Decision Memo Released
11/19/2002

Contacts

Lead Analysts
Anthony Norris
Lead Medical Officers
Carlos Cano, MD

Medicare Benefit Category Determination Date

Actions Taken

April 19, 2002

Initial Posting

August 2, 2002

The due date is extended to September 3, 2002 to complete review of FDA labeled indications and review of decision memorandum.

September 9, 2002

Due date extended to October 2, 2002 for final internal review and comment.

November 19, 2002

Decision memorandum  posted announcing CMS intention to noncover MECT.

January 2003

Claims processing instructions issued and NCD updated