WASHINGTON—The 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.”
HCFA’s 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 HCFA’s 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 contractors—the private companies that by law process and pay Medicare claims—HCFA 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.
