Medicare to more than double reimbursement for CCTA, likely spurring greater demand
Medicare will more than double payment for certain CT exams delivered in hospital outpatient settings, the federal payment program announced on Friday.
Beginning Jan. 1, CMS will up the rate for cardiac computed tomography angiography from $175 to $357. Medical societies have long advocated for the change and celebrated it Friday.
“We’re thrilled with the [CMS] ruling, which better aligns with the cost of providing CCTA services,” Ahmad Slim, MD, chair of the Society of Cardiovascular Computed Tomography’s Health Policy and Practice Committee, said in a Nov. 1 statement. “This is a huge win for U.S. providers as well as the entire cardiac imaging community, ultimately improving patient access to this essential diagnostic tool, which aligns with the society’s overall mission.”
Medicare is reassigning CCTA into a higher ambulatory payment classification as part of the Hospital Outpatient Prospective Payment System final rule issued Friday. CCTA revenue codes 75572, 75573 and 75574 were all assigned to APC 5572, SCCT noted. The society believes this change better reflects the “resource intensity required to perform CCTA” while also encouraging “broader use for better patient outcomes.”
Imaging AI vendor HeartFlow celebrated the payment update Nov. 1. The Mountain View, California-based company’s solutions are applied to CCTA exams to predict future heart risk. HeartFlow noted that Medicare also is increasing global payment for CCTA to $318 under the physician fee schedule. Commercial payment for the exam can range from $175 to $2,500. The vendor urged physicians to work with commercial payers, ensuring their contracts “reflect the updated CMS rates and the recognized value of CCTA.”
Physicians have increased use of the exam by an annual average of 20% over the last five years, experts estimated.
“This reimbursement reflects CMS’ recognition of the benefits CCTA offers, including superior imaging versus other noninvasive imaging modalities, efficient patient pathway guidance, and reductions in unnecessary tests,” Maros Ferencik, MD, PhD, president of SCCT and a professor of radiology at Oregon Health & Sciences University, said in a separate announcement from HeartFlow. “This is an exciting step forward for healthcare providers.”
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.