U.S. CMS agrees to double reimbursement for cardiovascular CT services

The U.S. Centers for Medicare and Medicaid Services (CMS) approved a reclassification of coronary computed tomography angiography (CCTA) into a higher ambulatory payment classification (APC) as part of the CY25 Hospital Outpatient Prospective Payment System (HOPPS) final rule, doubling Medicare reimbursement.

This highly anticipated update doubles the CCTA payment rate from $175 to $357.13, aligning Medicare reimbursement more appropriately with the value CCTA provides in cardiac care.

“We’re thrilled with the CMS’s ruling, which better aligns with the cost of providing CCTA services,” said Ahmad Slim, MD, FSCCT, chair of the Society of Cardiovascular Computed Tomography (SCCT) Health Policy and Practice Committee (HPPC). “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.”

APCs are part of the Outpatient Prospective Payment System (OPPS) used by CMS to determine reimbursement rates for hospital outpatient services. CCTA revenue codes 75572, 75573 and 75574 were all assigned to APC 5572.

The reclassification of CCTA to a higher APC means hospitals will now receive more appropriate compensation, reflecting the resource intensity required to perform CCTA and encouraging its broader use for better patient outcomes.

Revenue codes describe the type or location of services billed by a hospital. Historically, hospitals were confined by payer edits to use a lower-paying radiology revenue code (0350) for CCTA. At the end of 2023, CMS issued a clarification, acknowledging the inappropriate edit and reiterating that revenue code selection is at the discretion of hospitals.

Dr. Slim explained that by increasing the payment rate through a higher APC and ensuring the use of cardiology revenue codes, hospitals are now better equipped to offer CCTA services, which can help in early detection and management of coronary artery disease.

The SCCT HPPC has advocated for fair and sustainable CCTA reimbursement for over 6 years.

“We extend our heartfelt gratitude to the entire cardiovascular imaging community for their efforts and contributions,” said Dr. Slim. “This small coding adjustment creates large ripples of impact, alleviating financial pressure on struggling medical practices and potentially expanding cardiac CT testing at more sites across the country, ensuring better patient access to this cost-efficient exam. Every contributing voice was an asset to this advancement forward.”

What should hospitals do now that CMS has approved this change?
Hospitals should use the cardiology revenue code (0480) for CCTA services, when appropriate. Revenue cycle and billing departments should ensure that systems are updated to reflect the new APC and revenue code usage. Hospitals are encouraged to verify compliance with their Medicare Administrative Coordinator (MAC) to ensure appropriate billing under the new rules.

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About the Society of Cardiovascular Computed Tomography
Founded in 2005, the Society of Cardiovascular Computed Tomography (SCCT) is the international professional society devoted to improving health outcomes through effective use of cardiovascular computed tomography (CCT), with members from over 85 countries. SCCT is a community of physicians, scientists and technologists advocating for access, research, education and clinical excellence in the use of CCT. For more information, please visit https://scct.org/. 

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