CMS Changes Status Indicator for New Procedure to Assess Coronary Disease Severity Using CCTA

Effective January 1, 2021 CMS assigned CPT code 0625T (Automated quantification and characterization of coronary atherosclerotic plaque to assess severity of coronary disease, using data from coronary computed tomographic angiography; computerized analysis of data from coronary computed tomographic angiography) to OPPS status indicator “E1”. This status indicated that the code was not payable by Medicare because the device associated with the code did not have FDA clearance. However, the device received FDA clearance in October 2020. CMS thus reassigned 0625T from status indicator E1 to S (Procedure of Service; Not Discounted When Multiple, separate APC assignment), and assigned it to APC 1511 (New Technology – Level 11 ($900 - $1000) effective October 1, 2022. Table 6 of CMS Change Request 12885 lists the official long descriptor, status indicator, and APC assignment for 0625T. The payment rate for 0625T is $950.50 and can be found in Addendum B of the October 2022 OPPS Update.