Centers for Medicare & Medicaid Services

Content Section

Publication Number

100-3

Manual Section Number

20.30

Version Number

Effective Date of this Version

5/12/2008

Implementation Date

8/25/2008

Benefit Category

Diagnostic Tests (other)

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. )

Transmittal Number

Transmittal Link

http://www.cms.hhs.gov/transmittals/downloads/R88NCD.pdf

Revision History

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

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

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.