HRS Urges CMS to Clarify NCD Shared Decision-Making Requirement for LAAC

On June 28th, the Heart Rhythm Society, the Society for Cardiovascular Angiography and Interventions (SCAI), and the American College of Cardiology (ACC) sent a letter to the Centers for Medicare & Medicaid Services (CMS) regarding misinterpretation of the National Coverage Determination (NCD) shared decision-making requirement for percutaneous left atrial appendage closure (LAAC). 

The NCD requires a "formal shared decision-making interaction with an independent non-interventional physician using an evidence-based decision tool on oral anticoagulation in patients with NVAF prior to LAAC." Some Medicare Administrative Contractors are misinterpreting the requirement to mean that it cannot be fulfilled by a non-implanting electrophysiologist or interventional cardiologist. HRS, SCAI and the ACC have requested to meet with CMS to clarify the intention of the requirement, and urge the agency to educate the MACs accordingly to ensure the NCD language for shared decision-making is properly understood.