CMS assigns new code and payment rate for automated CCTA coronary plaque assessment

The Centers for Medicare and Medicaid Services recently assigned a new Current Procedural Terminology code pertaining to the realm of coronary computed tomographic angiography (CCTA). 

The new CPT code is specific to the automated quantification and characterization of coronary atherosclerotic plaque. This is the first code that will deliver reimbursement for computerized coronary plaque quantification and characterization. 

The new code can be billed alongside the Level I reimbursement for interpretations of CCTA exams. In September, CMS said the code would have an assigned payment rate of $900-$1,000. It became effective starting on October 1, 2022. 

The Radiological Society of North America (RSNA) praised the CMS for the update to the Hospital Outpatient Prospective Payment System (OPPS), stating that is was in concordance with the goals of the RSNA Quantitative Imaging Biomarkers Alliance (QIBA), which is committed to advancing and improving quantitative imaging. 

“Quantitative imaging biomarkers with high repeatability and reproducibility are one way to provide improved patient care and lower the cost of health care,” Timothy J. Hall, PhD, QIBA chair and professor in the Departments of Medical Physics and Biomedical Engineering at the University of Wisconsin, said in an RSNA news item. 

Previously, the code 0625T, which represents the automated quantification and characterization of coronary atherosclerotic plaque, had a status indicator of “E1.” This meant that it was not considered payable by Medicare due to the device associated with the code not yet having received the FDA’s approval. However, the device has since been given the FDA green light, which was what led to CMS changing the code’s status indicator to “S,” meaning it is eligible for payment under the OPPS. It has a separate Ambulatory Payment Classification assignment, per the CMS update. 

For more information, including the code's official long descriptor, status indicator and APC assignment for CPT code 0625T, click here (Table 6, attachment A). 

Cardiologists and radiologists deeply involved cardiac CT say coronary soft plaque assessments may be a game changer in cardiology. They say it has the possibility to begin screenings and prevention for coronary artery disease (CAD) much earlier before calcium forms in the vessels and long before any symptom onset.

Read more topic:

Cardiac CT soft plaque assessment may offer paradigm shift for coronary disease screening

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VIDEO: New Technologies in Cardiac CT Imaging

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In addition to her background in journalism, Hannah also has patient-facing experience in clinical settings, having spent more than 12 years working as a registered rad tech. She joined Innovate Healthcare in 2021 and has since put her unique expertise to use in her editorial role with Health Imaging.

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