WASHINGTONThe Health Care Financing Administration (HCFA) has
announced a national decision that Medicare will cover cryosurgery
for patients with localized prostate cancer. The decision rescinds an
October 1996 ruling against such coverage, which HCFA said reflected
a lack of conclusive scientific evidence at that time in favor of the
procedure. Additional evidence supporting its effectiveness led HCFA
to reverse itself and grant coverage.
As new scientific evidence becomes available, we will
reconsider national coverage issues, said HCFA administrator Nancy-Ann
DeParle. This decision demonstrates how HCFA, the medical
community, patient advocacy groups, and the industry can work
together to make sure beneficiaries have access to safe and effective
treatments that are medically necessary.
HCFAs national decision covers cryosurgery as primary treatment
for localized prostate cancer. Under the national coverage policy,
however, cryosurgery as a treatment of last resort continues to be a
non-covered Medicare service.
Our decision means beneficiaries will have greater access to
cutting-edge technology to combat prostate cancer, said Grant
Bagley, MD, director of HCFAs Coverage and Analysis Group.
Medicare beneficiaries will now have another option to discuss
with their doctors to help determine their treatment.
While most Medicare coverage decisions are made locally by HCFA
contractorsthe private companies that by law process and pay
Medicare claimsHCFA makes national coverage decisions that
apply nationwide and supersede local policies. When HCFA issues
coverage instructions to its carriers, which include coding and
billing information, it will also specify an effective date when
payment will be available.