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3 Steps For Getting the Most from Your Cardiac CTA Program?

Start by reviewing: CCTA Reimbursement Updates for 2025 below and align your charges as seen in 1, 2, 3.

U.S. CMS doubles reimbursement for cardiovascular CT services

reimbursement for cardiovascular CT services
The U.S. Centers for Medicare and Medicaid Services (CMS) has released its final rule for 2025 reimbursement: Coronary CTA (CCTA) has been elevated to a new Ambulatory Payment Classification (APC) classification, doubling reimbursement for this procedure in the hospital setting (OPPS) and increasing payment in the physician office setting (PFS) effective January 1, 2025. [1],[2]
  1. This highly anticipated update doubles the CCTA payment rate from $175 to $357.13, aligning Medicare reimbursement more appropriately with the value CCTA provides in cardiac care. This is a win for U.S. providers as well as the entire cardiac imaging community, ultimately improving patient access to this essential diagnostic tool.
  2. What should hospitals do now that CMS has approved this change?
    Hospitals should use the cardiology revenue code (0480) for CCTA services, when appropriate.
  3. New Category I CPT code issued for AI-enabled coronary plaque analysis software
The American Medical Association (AMA) has issued a new Category I CPT code for artificial intelligence (AI) based platforms that quantify coronary plaque buildup in imaging results and identify signs of coronary artery disease (CAD).[3] The update, scheduled to take effect in January 2026, covers AI offerings from multiple companies, including HeartFlow, Cleerly and Elucid. These technologies work by evaluating coronary CT angiography images and then alerting clinicians of any findings that represent CAD and high-risk features for heart attacks.

Coding: Plaque Analysis will be billed with the 4 CPT Category III codes approved for automated plaque analysis, effective late November 2024

CPT Category III codes

Announcement comes days after CMS expanded Medicare coverage for these platforms.

October has been a historic month for AI-powered coronary plaque analysis. Just days ago, the finalized a new local coverage determination (LCD) that expanded Medicare coverage for these same technologies. Four of seven Medicare Administrative Contractors (MACs) agreed to the updated policy, which went into effect on Nov. 24.

Now that you see how to improve your revenue capture in 3 simple steps, can the rest of your CCTA program performance use a boost in revenue performance through improved efficiencies?

Pulse Imaging Consultants has more ways to improve your Cardiac CTA program, improving throughput, patient and provider satisfaction, and improving overall performance. Contact us if you would like to know more.

[1] https://scct.org/news/news.asp?id=685976

[2] https://www.federalregister.gov/documents/2024/11/27/2024-25521/medicare-and-medicaid-programs-hospital-outpatient-prospective-payment-and-ambulatory-surgical

[3] https://www.ama-assn.org/system/files/sept-2024-summary-of-panel-actions.pdf

[4] https://scct.org/page/HOPPScy25?_zs=6VO6X&_zl=DemW4
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3 Steps For Getting the Most from Your Cardiac CTA Program?

Start by reviewing: CCTA Reimbursement Updates for 2025 below and align your charges as seen in 1, 2, 3.

U.S. CMS doubles reimbursement for cardiovascular CT services

reimbursement for cardiovascular CT services
The U.S. Centers for Medicare and Medicaid Services (CMS) has released its final rule for 2025 reimbursement: Coronary CTA (CCTA) has been elevated to a new Ambulatory Payment Classification (APC) classification, doubling reimbursement for this procedure in the hospital setting (OPPS) and increasing payment in the physician office setting (PFS) effective January 1, 2025. [1],[2]
  1. This highly anticipated update doubles the CCTA payment rate from $175 to $357.13, aligning Medicare reimbursement more appropriately with the value CCTA provides in cardiac care. This is a win for U.S. providers as well as the entire cardiac imaging community, ultimately improving patient access to this essential diagnostic tool.
  2. What should hospitals do now that CMS has approved this change?
    Hospitals should use the cardiology revenue code (0480) for CCTA services, when appropriate.
  3. New Category I CPT code issued for AI-enabled coronary plaque analysis software
The American Medical Association (AMA) has issued a new Category I CPT code for artificial intelligence (AI) based platforms that quantify coronary plaque buildup in imaging results and identify signs of coronary artery disease (CAD).[3] The update, scheduled to take effect in January 2026, covers AI offerings from multiple companies, including HeartFlow, Cleerly and Elucid. These technologies work by evaluating coronary CT angiography images and then alerting clinicians of any findings that represent CAD and high-risk features for heart attacks.

Coding: Plaque Analysis will be billed with the 4 CPT Category III codes approved for automated plaque analysis, effective late November 2024

CPT Category III codes

Announcement comes days after CMS expanded Medicare coverage for these platforms.

October has been a historic month for AI-powered coronary plaque analysis. Just days ago, the finalized a new local coverage determination (LCD) that expanded Medicare coverage for these same technologies. Four of seven Medicare Administrative Contractors (MACs) agreed to the updated policy, which went into effect on Nov. 24.

Now that you see how to improve your revenue capture in 3 simple steps, can the rest of your CCTA program performance use a boost in revenue performance through improved efficiencies?

Pulse Imaging Consultants has more ways to improve your Cardiac CTA program, improving throughput, patient and provider satisfaction, and improving overall performance. Contact us if you would like to know more.

[1] https://scct.org/news/news.asp?id=685976

[2] https://www.federalregister.gov/documents/2024/11/27/2024-25521/medicare-and-medicaid-programs-hospital-outpatient-prospective-payment-and-ambulatory-surgical

[3] https://www.ama-assn.org/system/files/sept-2024-summary-of-panel-actions.pdf

[4] https://scct.org/page/HOPPScy25?_zs=6VO6X&_zl=DemW4
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Cardiac CT Site Colorado

New Cardiac CT site opened in the Mountain Region of Colorado!

Another successful initiation of cardiac CT program happened last week. In Colorado mountain region where patients frequently must be air transferred to the nearest cath lab, a CCTA can significantly improve care of local patients and visitors by rapid triaging of acute patients and avoiding many unnecessary transfers to Denver.

This program will serve residents by facilitating earlier diagnostic workups for chest pain and keeping patients local, decreasing the amount of travel required to care. This cardiac CT program is also equipped with some of the newest AI programs that supplement anatomical CT images with plaque analysis and CT FFR information, providing more information to support physicians with treatment planning.

How can cardiac CT support your program with early diagnosis and keeping patient care local?
Read More
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336.283.7004

info@pulseimagingconsultants.com

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