Cardiology revenue code use improving

Continued action needed to protect CCTA reimbursement

Recent Medicare claims data indicate greater use of revenue codes that could help preserve the current Ambulatory Payment Classification (APC) placement for coronary computed tomography angiography (CCTA). There has been a gradual shift in revenue code usage, from 035x in 2024 toward increased utilization of 048x codes in 2025. Specifically, cardiology revenue codes have risen from zero in 2024, since the removal of an improper claim edit by CMS, to a range of 9 to 18 percent based on CPT code in the second quarter of 2025.  
 
CMS recently approved a temporary reclassification of CCTA into a higher APC (5572 from 5571). However, if the majority of hospitals do not use cardiology revenue codes (e.g., 480, 489, or 409x) over the next 3 years, reimbursement could fall by half. CMS has clarified that hospitals are free to update their cost reports and make corresponding revenue code changes on their billed claims. Hospitals should use the revenue code associated with their cost to perform CCTA tests — and very often, these are cardiology costs, such as a cardiology nurse to administer medication — even if cardiac CT is done in the radiology department. Different costs related to these tests, such as depreciation of the CT equipment or cardiology nurse time, contribute to the unique, higher operating costs of performing these tests.
 
Reach out to your billing department to ask about cardiology code usage at your facility. SCCT has resources to help.