Radiology benefits manager updates coverage guidelines to include imaging AI software
Radiology benefits manager EviCore recently updated its coverage guidelines to include certain artificial intelligence software for analyzing CT images.
The Bluffton, South Carolina-based company—which advises leading health insurers—now recommends reimbursement for AI that assesses heart scans. These new guidelines take effect on Oct. 1, with coverage endorsed for patients with acute or stable chest pain and stenoses found on coronary computed tomography angiography.
Vendors providing such products include Cleerly, Heartflow and Elucid. The radiology benefit manager’s decision comes after Medicare also recently opted to pay for CCTA AI.
“EviCore’s updated guidelines recommending coverage of AI-enabled coronary plaque analysis technology lay the foundation for broader payer coverage and expanded patient access to this groundbreaking technology to quantify and characterize plaque buildup in the coronary arteries,” Ron Blankstein, MD, director of cardiac CT at Brigham and Women's Hospital, said in a July 11 announcement from California-based HeartFlow. “Early detection and quantification of plaque using precise AI-driven tools enables us to offer personalized treatments sooner, with the opportunity to improve outcomes for our patients.”
A new CMS rule that went into effect Jan. 1 also doubled the amount paid to hospitals and associated outpatient facilities delivering cardiac CT scans—from $175 to $357.13 for the technical component, Elucid noted in a separate announcement. As of late last year, 5 of the 7 Medicare Administrative Contractors had OK’d coverage for AI-backed CCTA analysis. This has led to the software being available to over 70% of eligible Medicare patients.
“EviCore’s updated coverage guidelines demonstrate the increased understanding of the value of non-invasive coronary plaque analysis…,” Elucid CEO Kelley Huang, PhD, said in a statement.
The new EviCore guidelines are available as a PDF here (see pages 82-84).
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.