The Centers for Medicare and Medicaid Services (CMS) has internally generated a national coverage analysis (NCA) in order to examine the best treatment for patients with atherosclerotic renal artery stenosis (ARAS) and develop a national coverage determination (NCD) for PTA and stenting of the renal arteries.

Currently, Medicare covers percutaneous transluminal angioplasty (PTA) of the renal arteries “for patients in whom there is an inadequate response to a thorough medical management of symptoms and for whom surgery is the likely alternative. The PTA for this group of patients is an alternative to surgery, not simply an addition to medical management” (Medicare NCD Manual, 20.7 B1).  Medicare coverage of renal artery stenting is at the discretion of local Medicare contractors.

In 2006, the Agency for Healthcare Research and Quality (AHRQ) issued a report summarizing the evidence evaluating the effect and safety of angioplasty with stent placements and medical therapies in the treatment of atherosclerotic renal artery stenosis (ARAS) [link to http://effectivehealthcare.ahrq.gov/synthesize/reports/execSummary.cfm?Topic=42]. The National Institutes of Health (NIH) has sponsored the Cardiovascular Outcomes in Renal Atherosclerotic Lesions (CORAL) trial to examine which patients with ARAS would benefit from angioplasty with stent placement versus aggressive medical therapy. Due to the recent increase in concern regarding renal artery PTA and stenting and external questions regarding Medicare’s impact on current research and utilization of these procedures, we are initiating this reconsideration. 

Alan Garber, M.D., PhD Chair
Alex Krist, MD, Vice Chair
Steve Phurrough, MD, MPA, Coverage and Analysis Group
Michelle Atkinson, Executive Secretary

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