NCD20.30 MICROVOLT T-WAVE ALTERNANS (MTWA)

 

 

Effective Date of this Version

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

 

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) known as the T-wave.

o 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.

o These electrodes detect tiny beat-to-beat changes, on the order of one-millionth of volt, in the EKG T-wave.

o Spectral analysis is used to calculate these minute voltage changes.

o Spectral analysis is a sensitive mathematical method of measuring and comparing time and the EKG signals.

o Software then analyzes these microvolt changes and produces a report to be interpreted by a physician.

 

 

Indications and Limitations of Coverage

 

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.

 

 

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.

 

 

Other

 

• N/A

• (This NCD last reviewed May 2008.)

 

 

Coverage Transmittal Link

 

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

 

 

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.

• Original consideration for Microvolt T-wave Alternans (CAG-00293N) opens in new window

• First reconsideration for Microvolt T-wave Alternans (CAG-00293R) opens in new window

 

Medicare NCD Link