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Issues Currently under Coverage Review
External Counterpulsation Therapy Issue #CAG-00003
Medicare Coverage Issues Manual Section 35-74
(For more information contact Ron Milhorn)
35-74
ENHANCED EXTERNAL COUNTERPULSATION (EECP) FOR SEVERE ANGINA--COVERED EFFECTIVE _____________
Enhanced external counterpulsation (EECP) is a non-invasive outpatient treatment for
coronary artery disease refractory to medical and/or surgical therapy. Although devices used in this therapy are cleared by the Food and Drug Administration (FDA) for use in treating a variety of conditions, including stable or unstable angina pectoris, acute myocardial infarction and cardiogenic shock, Medicare coverage is limited to its use in patients with angina pectoris,
since only that use has developed sufficient evidence to demonstrate its medical effectiveness.
Other uses of this device remain non-covered.
Coverage is provided for the use of EECP for patients who have been diagnosed with disabling angina(Class III or Class IV, Canadian Cardiovascular Society Classification or equivalent classification) who, in the opinion of a cardiologist or cardiothoracic surgeon, are not readily
amenable to surgical intervention, such as PTCA or cardiac bypass because: (1) their
condition is inoperable, or at high risk of operative complications or post-operative failure; (2) their coronary anatomy is not readily amenable to such procedures; or (3) they have co-morbid states which create excessive risk.
A full course of therapy usually consists of 35 one-hour treatments, which may be offered once or twice daily, usually 5 days per week). The patient is placed on a treatment table where their lower extremities are wrapped in a series of three compressive air cuffs which inflate and
deflate in synchronization with the patient's cardiac cycle.
During diastole the three sets of air cuffs are inflated sequentially (distal to proximal)
compressing the vascular beds within the muscles of the calves, lower thighs and upper thighs. This action results in an increase in diastolic pressure, generation of retrograde arterial blood flow and an increase in venous return. The cuffs are deflated simultaneously just prior to
systole, which produces a rapid drop in vascular impedance, a decrease in ventricular workload and an increase in cardiac output.
The augmented diastolic pressure and retrograde aortic flow appears to improve myocardial perfusion, while systolic unloading appears to reduce cardiac workload and oxygen requirements. The increased venous return coupled with enhanced systolic flow appears to
increase cardiac output. As a result of this treatment, most patients experience increased |
