Magnetic Resonance Imaging (MRI) in Medicare Beneficiaries with Implanted Permanent Pacemakers (PMs) or Implantable Cardioverter Defibrillators (ICDs)

Effective for claims with dates of service on or after February 24, 2011, CMS will allow for coverage of MRI for Medicare beneficiaries with implanted permanent pacemakers (PMs) or implantable cardioverter defibrillators (ICDs) when those beneficiaries are enrolled in clinical studies that are approved by CMS for the purpose of gaining further evidence about the utility and safety of MRI exposure. Coverage under the Coverage with Evidence Development (CED) paradigm is contingent on all the criteria at Section 220.2.C.1 of the Medicare National Coverage Determinations (NCD) Manual, being met. Payment for an MRI examination is not currently covered by Medicare if certain contraindications are present. These include cardiac PMs. In June 2010, CMS received an external request to remove the contraindications for MRI for patients with implanted permanent PMs, as well as to provide Medicare coverage for patients who undergo MRI with an ICD in a clinical trial setting. As a result of the CMS review, CR 7296 allows for an exception in coverage for patients in clinical studies approved by CMS, but retains the contraindications in other circumstances.