CaverMap Medicare coverage torched
This article was originally published in The Gray Sheet
Executive Summary
CMS concludes that Blue Torch Medical's CaverMap prostate nerve diagnostic "is not reasonable and necessary" for beneficiaries undergoing nerve-sparing prostatic or colorectal surgical procedures in an Aug. 24 final coverage decision. The agency cites inadequate evidence in its national noncoverage determination. The firm did not anticipate a favorable decision, yet it requested the decision be opened in 2005 in a strategy to quash uncertainty about reimbursement caused by inconsistent coverage by local Medicare contractors. "Utilization is higher when the coverage status of a procedure is clear, whether it's positive or negative," Blue Torch reimbursement specialist Jerry Stringham said in a December interview (1"The Gray Sheet" June 19, 2006, p. 16)...