New clarification from CMS on billing CCTA

New clarification from CMS on billing CCTA to the appropriate higher cost-to-charge revenue codes

The Centers for Medicare & Medicaid Services (CMS) has published a rectification in its January 2024 OPPS transmittal that allows for CCTA to be reported with appropriate revenue codes that have higher codes, better reflecting the clinical departments which possess the majority of staff and other expenses to furnish such tests

Clinical charge masters can be updated to indicate that revenue codes for CCTA tests can be linked to revenue codes 0489x (Cardiology – Other) or 0409x (Other Imaging Services), respectively, which historically have higher cost-to-charge ratios.

The CMS Office of Transformation stated: “We recently identified an outdated return-to-provider (RTP) HCPCS-to-revenue code edit that resulted in certain claims submissions being limited to specific revenue codes for CPT codes 75572, 75573, and 75574. These claims were returned to the providers for resubmission. The outdated edit has been removed; and providers, when appropriate, may begin billing these codes with any appropriate revenue code.” ¹

This change is in response to SCCT advocacy efforts for CMS to improve the Hospital Outpatient Prospective Payment System (OPPS) payment rates for CCTA services. SCCT encourages members to speak to hospital administration and have their revenue codes updated for CCTA tests.

¹CMS Manual System, Pub 100-04 Medicare Claims Processing – Transmittal 12421 – Item 19