Imaging providers must act to preserve higher CT pay, American College of Radiology warns

Hospital-based imaging providers must take action to preserve higher reimbursement for certain CT exams, the American College of Radiology warned recently. 

The Centers for Medicare & Medicaid Services previously announced that it was temporarily reassigning payment codes for coronary CT angiography, or CCTA, under the hospital outpatient rule. With the change, CCTA moved from Level 1 imaging with contrast to Level 2, resulting in a 104% higher technical fee, rising from $175 in 2024 up to $357 last year. 

ACR reported in a Jan. 8 news update that Medicare made this change to reflect “the resource intensity and clinical value of CCTA services.” However, the pay boost comes with a caveat. 

“If less than 50% of hospitals update their billing practices over the next several years, CMS will revert to the lower [ambulatory payment classification], reducing reimbursement,” according to joint guidance from ACR, the American College of Cardiology and the Society of Cardiovascular Computed Tomography. 

Current Procedural Terminology (CPT) codes impacted by the change include 75572–75574, which remain under the Level 2 classification in 2026, but on a provisional basis. ACR and the other two societies are urging hospital imaging providers to update their charge masters, mapping CPT codes to the most appropriate revenue codes. They’re also advising revenue cycle managers and billing departments to ensure that billing systems and clearing houses accept the updated cardiology or general imaging revenue codes for CCTA. It’s also wise to monitor payer responses to claims and address any denials or inconsistencies, according to the ACR/ACC/SCCT guidance.

The American College of Radiology additionally published a new Q&A with Juan Carlos Batlle, MD, MBA, an attending radiologist and clinical assistant professor at the University of Pennsylvania in the cardiothoracic division. In it, he discusses background about this issue and why the ACR and others are focused on it. 

“For this reclassification to become permanent, hospitals are expected to change the revenue codes billed on claims for CCTA tests. Facilities now need to back this up by actually reporting their expenses in line with what the new [ambulatory payment classification] expects,” Batlle said in the piece, published Jan. 12 in ACR’s Bulletin. “If facilities continue to report that CCTA expenses are similar to generic CT expenses (by continuing to utilize the same CT revenue code for both), the APC change may be reversed.”