Recent updates from the Centers for Medicare & Medicaid Services have introduced significant changes in the reimbursement landscape for advanced cardiovascular imaging services, including CCTA, fractional flow reserve derived from computed tomography (FFR-CT), and AI-enabled coronary plaque analysis.

This ACC-SCCT CV business white paper provides practical guidance on aligning revenue code assignments with cost centers to protect future reimbursement, optimizing chargemaster structures, and preparing for CPT and Ambulatory Payment Classification transitions. Use this paper to educate revenue cycle and coding staff to minimize denials and compliance risk.

What Happens Without Proactive Revenue Code Alignment?

Failure to align cardiology services with the appropriate revenue codes will undermine the accuracy of CMS cost data over the next two to three years. Without this alignment, the cost reporting foundation that justified moving CCTA to APC 5572 – and effectively doubling reimbursement in 2025 – will erode. The same trajectory applies to FFR-CT. If hospitals continue to misreport charges under inaccurate revenue codes, CMS will recalibrate payments downward, potentially resulting in a meaningful decrease in Medicare reimbursement for these services in future rulemaking.

Access the white paper

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.

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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• Send a comment letter to CMS
• Keep up the efforts to use cardiology revenue codes (048x, for example) — talk to your billing/financial administrator to confirm its use. Without your help, CCTA codes may lose APC 5572 placement and reimbursement could return to a lower rate.

Learn more

The four contractors for the U.S. Centers for Medicare and Medicaid Services (CMS) – including CGS, National Government Services (NGS), Palmetto GBA and Wisconsin Physicians Service Insurance Corporation (WPS) – provided updated LCDs for current procedural terminology (CPT) codes 0623T - 0626T.

Per the new LCDs, AI-CPA using coronary computed tomography angiography (CCTA) is considered reasonable and medically necessary as a diagnostic study when the patient is eligible for CCTA; and the patient presents with acute or stable chest pain and is at intermediate risk for coronary artery disease (CAD) or has evidence of CAD-RADS™ level 1, 2 or 3 disease on their CCTA; and the patient is negative or inconclusive for acute coronary syndrome (ACS).

The LCDs have a future effective date of Nov. 24, 2024.

Members of the Society of Cardiovascular Computed Tomography (SCCT) Health Policy & Practice Committee (HPPC) presented as subject matter experts during a May 2023 MAC-led Multijurisdictional Meeting on CAC Non-Invasive Technology for Coronary Artery Plaque Analysis and later provided comments on the draft LCDs that helped shape the final policies.

“This is a positive step towards improved patient care,” said Ahmad Slim, MD, FSCCT, director of imaging at Pulse Heart Institute and chair of the HPPC. “Increased access to AI-CPA, AI-augmented plaque assessment analysis tools, will help medical teams make more informed decisions for their patients, and have the potential to reduce unnecessary invasive procedures downstream."

In regard to the remaining MACs, Noridian has not published their final LCD, although it is expected within a few days. Novitas Solutions and First Coast Service Options, Inc. (FCSO) continue to consider coverage for AI-CPA on a case-by-case basis.

The SCCT HPPC offers tools for administrators to navigate the complex landscape of insurance plans, billing and reimbursement on SCCT website, scct.org.

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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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ARLINGTON, VA (August 12, 2024) – Reimbursement for coronary computed tomography angiography (CCTA) could potentially double for U.S. hospitals and outpatient services starting next year, after being chronically and significantly under-reimbursed.

Immediate Past President Ed Nicol, MD, MBA, MSCCT of the Society of Cardiovascular Computed Tomography (SCCT) made the announcement and call to action during the opening ceremony of the Society’s 19th Annual Scientific Meeting (SCCT2024) held in Washington, DC.

“I have to say, I did catch [the news] slightly by surprise last week, but what a great thing to happen just before our conference and a great time to be able to share this with you while also asking for your help,” he added in his opening comments. 

“That reimbursement level would make a huge difference to practices that struggle with cost issues and pave the way for more sites to offer cardiac CT, while still ensuring that CCTA is the most cost-efficient test. However, as mentioned in order to do this, we’re going to need your help.”

According to Nicol, Medicare has significantly under-reimbursed CCTA for years, despite it being a comparatively less costly test.

Medicare reimbursement for CCTA is currently only $175. This is because the U.S. Centers for Medicare and Medicaid Services (CMS) has grouped CCTA in the same category as general CT services, which is not appropriate for the time and effort that goes into CCTA exams and evaluation. 

In order to change the categorization, the revenue code needs to change to 048x, a cardiology code that will potentially double CCTA reimbursement.

CMS seeks comments by Sept. 9 to ascertain whether 50% or more hospital outpatient departments are using, have attempted, or would use a revenue cardiology code for CCTA tests if allowed. 

Current SCCT President Maros Ferencik, MD, PhD, MSCCT, described the proposed rule as the potential light at the end of a 6-year long tunnel of advocacy work that will require “all hands on deck” to pull us through it.

“Please bear in mind – and this is very important for our community, as we represent cardiology, radiology and other fields – that the use of a cardiology revenue code is not connected to how a hospital might allocate revenue of cardiac CT,” he said in the SCCT2024 closing ceremony. “It’ll really help us all – help the whole field – to get fair and sustainable reimbursement for cardiac CT."

What is the Hospital Outpatient Prospective Payment System (HOPPS) Proposed Rule?

• Read the full HOPPS rule

Whom this affects: 

All U.S. cardiac imagers who use CCTA. 

What SCCT needs:

 We need our members (ideally from hospitals and practices representing at least 50% of claims) and others backing the use of the revenue code 048x to send comment letters to CMS before Sept. 9, 2024.

• Submit comments online 

By sending a letter to CMS, advocating for the increased reimbursement, this generates higher awareness for the wider community and presents further information to CMS on why these rates should increase.
In addition to your letter, talk to your financial or billing administrator about the possibility of a revenue code change and encourage them to write a letter as well. 

Why now?

 We have been advocating for a new code for 6 years. This is the first time that CMS has expressed the willingness to change the payment rate for CCTA – in part due to a payer edit that was discovered and relayed to CMS in late 2023.

The more feedback we provide, the louder our voice can be. This is why our request to SCCT members is urgent and we need your help, even if (or maybe especially if) you've helped in the past.

SCCT has resources to help individuals and institutions to submit their comments on the society's website.

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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). SCCT is a community of physicians, scientists and technologists from over 85 countries advocating for access, research, education and clinical excellence in the use of CCT. For more information, please visit www.SCCT.org.

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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

Currently, the Medicare physician payment schedule, maintained by the Centers for Medicare and Medicaid Services (CMS) and utilized by many other payers, relies on 2006 cost information to develop practice expense relative values, the Medicare Economic Index and resulting physician payments. Given the changes that the U.S. economy and health care system have undergone since that time, including staffing costs, team-based care, inflation, new practice arrangements, and the wide-spread adoption of electronic health records and other information technology systems, practice expense payments no longer accurately reflect the relative resources that are typically required to provide physician services.

Therefore, this study is an opportunity for clinicians to make their voice heard and communicate accurate financial information to policymakers, including members of Congress and CMS. Mathematica, an independent research company with extensive experience in survey methods as well as health care delivery and finance reform, has been contracted by the AMA to conduct the study.

Electronic communication regarding the cost survey will be sent by Mathematica from the email address PPISurvey@mathematica-mpr.com with the subject line: “American Medical Association requests your input on physician practice expense and patient care hours.”

Invitations and reminders about physician hours worked will come from the email address PhysicianHoursSurvey@mathematica-mpr.com with the subject line: “Please help to update accurate physician payments.”

Throughout the spring of 2024, surveys will be distributed, and it is vital that individuals or practices who are randomly selected to complete a survey do so thoroughly and accurately. For financial information, SCCT members recommends relying on business and financial administrators in their practice to complete an online financial information survey. Other members will be asked to report hours spent actively providing patient care.

The feedback from physician practices and individual physicians who are randomly selected to participate in this study is critical for success, ensuring practice expenses and patient care hours are accurately reflected.

If you are selected for the survey and have questions regarding your response, contact SCCT’s Manager of Policy and Government Relations, Justin Sullivan at jsullivan@scct.org.

Throughout 2022, SCCT met with members of the House and Senate to advocate for inclusion of report language in the Appropriations bill urging CMS to address inadequate payment for cardiac computed tomography. The passed legislative package contains the following report language provided here and found on page 112 of the Labor-HHS Committee final explanatory statement:

• Cardiac Computed Tomography (CT).-The agreement notes that unstable and low Medicare payments for cardiac CT services is contributing to significant disparity in access to services among minority populations and encourages CMS to address this inequity.

SCCT is pleased that members of Congress supported this effort to address low reimbursement for cardiac CT. The text of the Consolidated Appropriations Act, 2023 is available here.

Read the letter to CMS

The Rules Committee recommendation will now be presented to the AMA Board of Trustees (BOT) for consideration.  If approved by the AMA BOT, the full AMA HOD will vote in June on the SCCT application.

The SCCT leadership is grateful to those members who joined the AMA to support this effort.  We will continue to provide updates as the application process.

Iowa member achieves local payer coverage

By Leslee J. Shaw, PhD, FSCCT, SCCT Co-Chair Advocacy

Enrico Martin, MD, Iowa Heart Center, is a proactive grassroots advocate who firmly believes that clinicians need to get involved in educating payers about cardiac CT.

His efforts to build relationships with payers and improve coverage policies recently paid off, when he convinced his local payer, Wellmark Blue Cross and Blue Shield, to waive prior authorization requirements for cardiac CT. 

"I'm hoping that our experience will set the stage for easing up on the burden of

preauthorization and also show clinicians the importance of policing ourselves and doing the right thing,” said Dr. Martin.