Medicare Physician Fee Schedule includes CPT code, $1,000 payment amount for imaging AI software

The Medicare Physician Fee Schedule released on Monday includes a Category 1 CPT code and $1,000 proposed payment amount for a key imaging AI assistant. 

CMS is suggesting such reimbursement for coronary plaque analysis software, offered by vendors Cleerly, Elucid and HeartFlow. Their products utilize artificial intelligence to analyze coronary CT angiography images for signs of heart disease. 

The move comes after radiology benefits manager EviCore also recently recommended that commercial insurers cover CCTA AI, signifying growing momentum for such software. 

“Elucid is encouraged by the addition of the Category 1 CPT code and payment level for coronary CTA with plaque analysis in the calendar year 2026 Medicare Physician Fee Schedule proposed rule,” Kelly Huang, PhD, CEO of the Boston-based vendor, said in a statement July 15. “We commend CMS for ensuring that the proposed payment level reflects the clinical value, technological investment, and expertise needed to perform this service, enabling Medicare beneficiaries to access this technology.”

In 2022 alone, heart disease claimed over 700,000 lives in the U.S., Elucid noted. This underscores the “urgent need” for early detection and intervention. CCTA analysis from the three vendors provides insights on patients’ plaque burden, composition and morphology. This allows for “more accurate identification of high-risk patients who may benefit from targeted medical therapy and lifestyle interventions.” 

The CMS proposal applies to Medicare Part B, which covers outpatient care, doctor’s visits and preventative services. If finalized, the decision is slated to take effect on Jan. 1. This comes after a previous CMS rule that went into effect in 2025 doubled the amount paid to hospitals who perform cardiac CT, from $175 to $357, Elucid noted.