House Republicans of Utah seek access to new, approved life-saving technology for state Medicare recipients with coronary artery disease

Utah’s Congressional Republicans, led by Congressman Chris Stewart (R-UT), are seeking to ensure Utah Medicare beneficiaries gain access to a life-saving, non-invasive technology used to diagnose coronary artery disease (CAD), the leading cause of death in the U.S. 

The technology, HeartFlow Fractional Flow Reserve Derived from CT (Heartflow FFRCT), is currently available to Medicare beneficiaries in 23 states but not to those in Utah. Over the next 10 years, 1.9 Million Utahns could benefit through the implementation of HeartFlow FFRCT.

Congressman Stewart, along with his fellow Congressional Republicans, wrote a letter expressing his ongoing interest in the appropriate reimbursement coverage for life-saving diagnostic testing for coronary artery disease (CAD). Congressman Stewart is “hopeful that this advanced technological diagnostic tool will soon be available to Medicare beneficiaries in our State” and he “looks forward to our citizens who are covered by Medicare receiving the same standard of care as elsewhere in the country.”

CAD is a massive and growing problem that will impact 209 Million Americans and 1.9 Million Utahns over the next 10 years“We state the obvious when we note that heart disease is the leading cause of death in the United States.”– Rep. Chris Stewart.  

HeartFlow FFRCT Analysis has been assigned a New Technology Ambulatory Payment Classification (APC) by the Centers for Medicare and Medicaid Services (CMS) and is covered by the majority of national US commercial health insurance companies—such as Aetna, Anthem, Cigna, and most Blue Cross and Blue Shield plans encompassing over 220 million Americans. Despite the New Technology APC, regional Medicare Administrative Contractors (MACs) are allowed to make individual coverage decisions for their regions, and the MAC covering Utah (Noridian) has so far only approved “claim-by-claim” coverage of the technology, which requires additional administrative and documentation requirements.

“We are delighted in the interest the Utah Congressional delegation has shown in improving cardiovascular care for cardiac patients in Utah and nationwide. At University of Utah Health, we are committed to ensuring patients have access to the best and most up to date care and the HeartFlow Analysis is an important tool towards that end.” – Frederick Welt, MD, Margaret Amundsen Professor of Cardiology, University of Utah Health Sciences Center.