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National Coverage Determination (NCD)

Microvolt T-Wave Alternans (MTWA)

20.30

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Tracking Information

Publication Number
100-3
Manual Section Number
20.30
Manual Section Title
Microvolt T-Wave Alternans (MTWA)
Version Number
2
Effective Date of this Version
05/12/2008
Ending Effective Date of this Version
01/13/2015
Implementation Date
08/25/2008
Implementation QR Modifier Date

Description Information

Benefit Category
Diagnostic Tests (other)


Please Note: This may not be an exhaustive list of all applicable Medicare benefit categories for this item or service.

Item/Service Description

A.     General

Microvolt T-wave Alternans (MTWA) testing is a non-invasive diagnostic test that detects minute electrical activity in a portion of the electrocardiogram (EKG) know as the T-wave.  MTWA testing has a role in the risk stratification of patients who may be at risk for sudden cardiac death (SCD) from ventricular arrhythmias.

Within patient groups that may be considered candidates for implantable cardioverter defibrillator (ICD) therapy, a negative MTWA test may be useful in identifying low-risk patients who are unlikely to benefit from, and who may experience worse outcomes from ICD placement.

The test is performed by placing highly sensitive electrodes on a patient's chest prior to a period of controlled exercise.  These electrodes detect tiny beat-to-beat changes, on the order of one-millionth of volt, in the EKG T-wave.  Spectral analysis is used to calculate these minute voltage changes.  Spectral analysis is a sensitive mathematical method of measuring and comparing time and the EKG signals.  Software then analyzes these microvolt changes and produces a report to be interpreted by a physician.
Indications and Limitations of Coverage

B. Nationally Covered Indications

Microvolt T-wave Alternans diagnostic testing is covered for the evaluation of patients at risk for SCD, only when the spectral analysis method is used.

C. Nationally Non-Covered Indications

Microvolt T-wave Alternans diagnostic test is non-covered for the evaluation of patients at risk for SCD if measurement is not performed employing the spectral analysis.

D. Other

N/A

(This NCD last reviewed May 2008.)
Cross Reference
Claims Processing Instructions

Transmittal Information

Transmittal Number
88
Coverage Transmittal Link
https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R88NCD.pdf
Revision History

03/2013 - CMS translated the information for this policy from ICD-9-CM/PCS to ICD-10-CM/PCS according to HIPAA standard medical data code set requirements and updated any necessary and related coding infrastructure. These updates do not expand, restrict, or alter existing coverage policy. Implementation date: 10/07/2013 Effective date: 10/1/2015. (TN 1199) (TN 1199) (CR 8197)

07/2008 - Effective Date: 05/12/2008. Implementation Date: 08/25/2008. (TN 88) (CR6154)

03/2006 - Effective Date: 03/21/2006. Implementation Date: 04/03/2006. (TN 49) (CR4351)
Other

National Coverage Analyses (NCAs)

This NCD has been or is currently being reviewed under the National Coverage Determination process. The following are existing associations with NCAs, from the National Coverage Analyses database.

Coding Analyses for Labs (CALs)

This NCD has been or is currently being reviewed under the National Coverage Determination process. The following are existing associations with CALs, from the Coding Analyses for Labs database.

Additional Information

Other Versions
Title Version Effective Between
Microvolt T-Wave Alternans (MTWA) 3 01/13/2015 - N/A View
Microvolt T-Wave Alternans (MTWA) 2 05/12/2008 - 01/13/2015 You are here
Microvolt T-Wave Alternans (MTWA) 1 03/21/2006 - 05/12/2008 View
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Reasons for Denial
Note: This section has not been negotiated by the Negotiated RuleMaking Committee. It includes CMS’s interpretation of it’s longstanding policies and is included for informational purposes. Tests for screening purposes that are performed in the absense of signs, symptoms, complaints, or personal history of disease or injury are not covered except as explicity authorized by statue. These include exams required by insurance companies, business establishments, government agencies, or other third parties. Tests that are not reasonable and necessary for the diagnosis or treatment of an illness or injury are not covered according to the statue. Failure to provide documentation of the medical necessity of tests may result in denial of claims. The documentation may include notes documenting relevant signs, symptoms, or abnormal findings that substantiate the medical necessity for ordering the tests. In addition, failure to provide independent verification that the test was ordered by the treating physician (or qualified nonphysician practitioner) through documentation in the physician’s office may result in denial. A claim for a test for which there is a national coverage or local medical review policy will be denied as not reasonable and necessary if it is submitted without an ICD-9-CM code or narrative diagnosis listed as covered in the policy unless other medical documentation justifying the necessity is submitted with the claim. If a national or local policy identifies a frequency expectation, a claim for a test that exceeds that expectation may be denied as not reasonable and necessary, unless it is submitted with documentation justifying increased frequency. Tests that are not ordered by a treating physician or other qualified treating nonphysician practitioner acting within the scope of their license and in compliance with Medicare requirements will be denied as not reasonable and necessary. Failure of the laboratory performing the test to have the appropriate Clinical Laboratory Improvement Act of 1988 (CLIA) certificate for the testing performed will result in denial of claims.
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