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Blue Torch Medical Gets What It Asked For In CMS Non-Coverage Proposal

This article was originally published in The Gray Sheet

Executive Summary

CMS proposed national non-coverage of Blue Torch Medical's CaverMap prostate nerve diagnostic - just as the company had hoped

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CaverMap Medicare coverage torched

CMS concludes that Blue Torch Medical's CaverMap prostate nerve diagnostic "is not reasonable and necessary" for beneficiaries undergoing nerve-sparing prostatic or colorectal surgical procedures in an Aug. 24 final coverage decision. The agency cites inadequate evidence in its national noncoverage determination. The firm did not anticipate a favorable decision, yet it requested the decision be opened in 2005 in a strategy to quash uncertainty about reimbursement caused by inconsistent coverage by local Medicare contractors. "Utilization is higher when the coverage status of a procedure is clear, whether it's positive or negative," Blue Torch reimbursement specialist Jerry Stringham said in a December interview (1"The Gray Sheet" June 19, 2006, p. 16)...

CaverMap Medicare coverage torched

CMS concludes that Blue Torch Medical's CaverMap prostate nerve diagnostic "is not reasonable and necessary" for beneficiaries undergoing nerve-sparing prostatic or colorectal surgical procedures in an Aug. 24 final coverage decision. The agency cites inadequate evidence in its national noncoverage determination. The firm did not anticipate a favorable decision, yet it requested the decision be opened in 2005 in a strategy to quash uncertainty about reimbursement caused by inconsistent coverage by local Medicare contractors. "Utilization is higher when the coverage status of a procedure is clear, whether it's positive or negative," Blue Torch reimbursement specialist Jerry Stringham said in a December interview (1"The Gray Sheet" June 19, 2006, p. 16)...

Blue Torch Aims Low: Negative Medicare NCD Could Boost Business, It Says

Blue Torch Medical paradoxically expects that a Medicare national non-coverage decision for its CaverMap diagnostic to assess a patient's risk of impotency after radical prostatectomy will lead to increased sales

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