CMS Pub. 100-03, ch. 1, § 20.30

A. General

Microvolt T-wave Alternans (MTWA) testing is a non-invasive diagnostic test that

detects minute electrical activity in a portion of the electrocardiogram (ECG) known as

the T-wave. MTWA testing has a role in the stratification of patients who may be at risk

for sudden cardiac death (SCD) from ventricular arrhythmias.

Within patient groups that may be considered candidates for implantable cardioverter

defibrillator (ICD) therapy, a negative MTWA test may be useful in identifying low-risk

patients who are unlikely to benefit from, and who may experience worse outcomes from,

ICD placement.

Spectral analysis (SA) is a sensitive mathematical method of measuring and comparing

time and the ECG signals. It requires specialized propriety electrodes to calculate minute

T-wave voltage changes. Software then analyzes these microvolt changes and produces a

report to be interpreted by a physician. The Modified Moving Average (MMA) method

uses a temporal domain in which T-wave alternans are assessed as a continuous variable

along the complete ECG. The MMA method of MTWA testing is performed using

standard ambulatory ECG equipment.

B. Nationally Covered Indications

Effective for dates of service on and after March 21, 2006, MTWA diagnostic testing is

covered for the evaluation of patients at risk for SCD, only when the SA method is used.

C. Nationally Non-Covered Indications

N/A

D. Other

Effective for dates of service on and after January 21, 2015, A/B MACs acting within

their respective jurisdictions may determine coverage of MTWA diagnostic testing for

the evaluation of patients at risk for SCD using all other methods.

(This NCD last reviewed January 2015.)