National Coverage Analysis (NCA) Tracking Sheet for Ultrasound Diagnostic Procedures (CAG-00309R)

Deltex Medical Group, manufacturer of the CardioQ esophageal Doppler monitor, has requested a reconsideration of the current NCD for ultrasound diagnostic procedures.  This NCD describes indications and limitations on coverage. Technologies are listed as either Category I (clinically effective, usually part of initial patient evaluation, may be an adjunct to radiologic and nuclear medicine diagnostic technique) or Category II (clinical reliability and efficacy not proven).  Medicare coverage is only extended to the procedures listed in Category I.  Techniques in Category II are considered experimental and are not covered.  Monitoring of cardiac output (Doppler) is placed in Category II.  Therefore, reimbursement for the use of esophageal Doppler monitoring to determine cardiac output and for hemodynamic management is not currently covered.

Deltex asserts in its request that the current NCD pre-dates the commercial availability of both the CardioQ and its predecessor devices (the EDM I and EDM II), much, if not all, of the validation data and all of the peer-reviewed, randomized controlled clinical trial data.  They request that esophageal Doppler monitoring should be covered in those patient groups that have been studied; specifically, ventilated patients in the ICU and operative patients with a need for intra-operative fluid optimization.  We are opening a National Coverage Analysis to determine if ultrasound monitoring of cardiac output is reasonable and necessary for Medicare beneficiaries.