National Coverage Analysis (NCA) Tracking Sheet for Cardiac Catheterization Performed In Other Than A Hospital Setting (CAG-00166N)

The Centers for Medicare and Medicaid Services (CMS) has discovered a discrepancy in section 35-45 of the Coverage Issues Manual (CIM). The policy states that cardiac catheterization may be covered in a freestanding clinic when the carrier, in consultation with the appropriate Peer Review Organization, determines that the procedure can be performed safely in all respects in the particular facility. The Peer Review Organizations (recently renamed Quality Improvement Organizations) ceased doing reviews of core freestanding, cardiac catheterization facilities in the early 1990s. Since the implementation of CIM 35-45, we are unaware of any emerging evidence that there is a greater risk of adverse events at these freestanding clinics. Therefore, CMS is opening this policy to review the evidence and correct the discrepancy.