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Coverage of Magnetic Resonance Imaging for Patients With Cardiac Devices: Improving the Coverage With Evidence Development Program.

Magnetic resonance imaging (MRI) is an essential imaging modality, particularly for diseases of the central nervous system such as acute strokes, cord compression, or intracranial malignancies.1 Historically, MRI has been contraindicated for patients with cardiac implantable electrical devices, eg, pacemakers and implantable cardioverter defibrillators, largely owing to safety concerns such as sudden device failure. More recent data now support the safety of performing MRIs in nearly all such patients under proper supervision.2 Yet few hospitals have clinical programs to provide this service in part owing to rules affecting Medicare reimbursement because payment in this case is only provided through the “coverage with evidence development” program. This program was intended to provide patients with early access to investigational technologies or novel use of established therapeutics. The MRI experience shows the ways in which these coverage decisions can be implemented in a problematic way.