National Coverage Analysis (NCA) Tracking Sheet

Intensive Behavioral Therapy for Cardiovascular Disease



Over the past 25 years, the Congress has expanded the Medicare benefit to include various preventive services to the Medicare Part B program such as Pap smear and screening pelvic exams, screening mammograms, colorectal cancer screening tests, and diabetes screening tests. Effective January 1, 2009, CMS was allowed to add coverage of "additional preventive services" if certain statutory requirements are met, as provided under Section 101(a) of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) (Pub. Law 110-275). Among other things, this new benefit allows CMS under 42 CFR 410.64 to cover "additional preventive services", if it determines through the NCD process that the service is recommended with a grade A (strongly recommends) or grade B (recommends) rating by the United States Preventive Services Task Force (USPSTF) and meets certain other requirements.

On October 29, 2010 the Centers for Medicare and Medicaid Services (CMS) received a formal request from Partnership for Prevention asking that CMS initiate a national coverage determination (NCD) for aspirin counseling for treatment of cardiovascular disease, which is recommended with a grade A by the USPSTF. The requestor asked CMS to cover this service once every 5 years or more frequently such as when relevant new risk factors are identified for at risk individuals who do not already have coronary artery disease or cardiovascular disease.

After reviewing the requestor's letter and the various preventive services that the USPSTF has given a grade A or grade B rating in recent years, CMS has decided to initiate a national coverage analysis (NCA) for Intensive Behavioral Therapy for Cardiovascular Disease, which includes assessment and counseling regarding aspirin use to prevent cardiovascular disease; blood pressure measurement, counseling and intervention; and healthy diet counseling in the form of intensive behavioral counseling for patients with hyperlipidemia and other known risk factors for cardiovascular and diet-related chronic conditions.

Benefit Category

Additional Preventive Services

Requestor Information

Requestor Name Requestor Letter
Jason M. Spangler, MD, Chief Medical Officer, Partnership for Prevention View Letter

Important Dates

Formal Request Accepted and Review Initiated
Expected NCA Completion Date
Public Comment Period
02/11/2011 - 03/13/2011
Proposed Decision Memo Due Date
Proposed Decision Memo Released
Proposed Decision Memo Public Comment Period
08/10/2011 - 09/09/2011
Decision Memo Released
Comments for this NCA
View Public Comments


Lead Analysts
Jamie Hermansen, MPP
Lead Medical Officers
Joseph Chin, MD, MS

Medicare Benefit Category Determination Date

Actions Taken

February 11, 2011

CMS opens the national coverage analysis and a 30-day public comment period begins.

March 13, 2011

The initial 30-day public comment period closes.

August 10, 2011

The proposed decision memorandum is posted and the 30-day public comment period begins.

November 8, 2011