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Coronary CTA Reimbursement For US Hospitals To Double In 2025

For once, cardiologists find good news in the US Centers for Medicare & Medicaid Services (CMS) annual Hospital Outpatient Prospective Payment System (HOPPS) final rule: in 2025 the payment rate for coronary computed tomography angiography (CCTA) will double.

Cardiac imagers have long lamented the fact that low reimbursement for CCTA has been a major hurdle limiting access to the technology, which currently has a class 1 recommendation in the latest American guidelines for the exclusion of obstructive coronary disease. Not only do these scans cost money to run, but also institutions must invest a significant amount of money in hardware, software, and trained personnel. Hence, many have not been able to afford to offer the tests under the current paradigm.

When CMS announced a proposed increase of its reimbursement to hospital-based programs from $175 to $357.13 over the summer, proponents of the CCTA celebrated a light at the end of a long advocacy tunnel.

Now, with the announcement of the final 2025 HOPPS final rule, CCTA will be reclassified into a higher ambulatory payment classification (APC) next year.

"By having this doubling in the hospital outpatient setting, this finally is going to allow facilities to say: this makes sense for us to invest in and patients are going to benefit," said Michael Coords, MD (RadNet, Los Angeles, CA), regulatory task force lead on the Society of Cardiovascular Computed Tomography (SCCT) Health Policy and Practice Committee.

The update reflects "a better understanding of what it takes to perform [CCTA] and how it is essentially different than your standard CT scan of the chest," he told TCTMD.

"We're thrilled with the CMS's ruling, which better aligns with the cost of providing CCTA services," said Ahmad Slim, MD (Pulse Heart Institute Cardiology Services, Tacoma WA), chair of the SCCT Health Policy and Practice Committee, in a press release. "This is a huge win for US 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."

Small Adjustment, Big Effect

All three of the following CCTA revenue codes have been assigned to APC 5572 and will be reimbursed similarly:

75572: Heart CT with contrast for evaluation of cardiac structure and morphology

75573: Heart CT with contrast for evaluation of cardiac structure and morphology in the setting of congenital heart disease

75574: CT angiography of the heart, coronary arteries, and bypass grafts with contrast

"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," Slim said.

While the specific proportion of hospitals that currently offer CCTA is unknown, Coords said, "it's not nearly enough," adding that he has had patients drive hours to be able to get scanned. The change in reimbursement "is going to certainly allow more facilities to start" offering CCTA as part of a "sustainable business model," Coords added.

Notably, he said, "the impact is going to be one of the most significant ones that I've seen in my career, because without this, people just wouldn't have the access that they deserve and need."

Coords specified that this change will only affect hospital-based programs, and not outpatient clinics. The latter will receive only a 12% increase in reimbursement as part of the Medicare Physician Fee Schedule and will still face challenges, "because margins are very tight, particularly for smaller groups," he said. While the 12% increase is objectively good news, it's not enough to overcome the gaps in what outpatient programs can afford, especially when it comes to hardware. "When you have better hardware, you can have lower radiation doses, you can scan more types of patients, and you can offer more types of exams that save lives," said Coords. "So it's not unique just to the hospital setting."

Coords said the SCCT plans to continue to advocate for increased reimbursement for CCTA in the outpatient setting and also to increase awareness and education around the technology, especially for referring cardiologists, primary care physicians, and patients.

He Thought His Heart Was In Perfect Health. An Advanced Scan Showed Something Alarming.

When Chris Abrunzo was in his early 20s, his father was struck by the kind of heart attack known as a "widow maker." The severe cardiac events are often fatal, and while Abrunzo's father survived, it inspired him to take his heart health seriously, since family history is one of the strongest indicators for developing heart disease later in life.

Abrunzo started getting regular cardiac checkups and he made sure to work out frequently and eat well. As the years passed, tests continued to show he was in great health except for some elevated cholesterol that he treated with medication. He had no symptoms of heart disease. In 2023, a family friend told him about a newer, more detailed test that offered a view of the arteries without any invasive procedures.

"I go in thinking I'm going to get a scan and be told 'You're doing a great job,'" Abrunzo recalled. "Well, I get scanned, and the scan reveals that I had areas of plaque buildup, many of which would not show up on an echocardiogram or a stress test, but that showed up on this scan. One of those areas was around 70% blocked."

High blockage in arteries can cause heart attacks. While the blockage Abrunzo found wasn't in a crucial artery, it was in a place that would be difficult to treat with surgery, so he knew he had to focus on reducing the buildup. He was prescribed more medications, and further adjusted his diet and exercise regimens. During a checkup last month, Abrunzo was told that the blockage was only occluding about 40% of his artery, putting him at far lower risk for a sudden cardiac event.

Chris Abrunzo, right. Chris Abrunzo

"I think this just the ability to look inside there is just something that's miraculous and probably saved my life, not in the very near future, but probably in my mid-50s," said Abrunzo, now 47. "It's like magic."

What is cardiac CT angiography?

A cardiac CT angiogram is a test that essentially conducts "a CAT scan for the heart," said Dr. Aeshita Dwivedi, a cardiologist at Northwell Health. The full-body scanner captures 3D images of the heart and the arteries that supply blood to the organ. Some scanners can take the image in less time than it takes a heart to beat. Doctors can study that 3D image for blockages, plaque buildup, and other warning signs for cardiac disease, Dwivedi said.

It's far more advanced than what more common noninvasive tests, like the echocardiograms and stress tests Abrunzo was doing, can do.

"Usually you have to have greater than a 70% blockage in the arteries to have an abnormality on a stress test," said interventional cardiologist Dr. Tony DeFrance. "And that's really kind of a problem, because a lot of times people have echocardiograms, calcium tests, stress tests, and they say 'Oh, you're fine, your heart's strong.' That probably means they don't have a 70% blockage. But we've found out over the last couple of decades it's not the 70% blockages that cause the heart attacks. It's often the 20% and 30% blockages."

The Arineta Spotlight Duo, a machine used for cardiac CT angiograms. Clear Heart and Lung Imaging

The test can also look at the plaque, or buildup of cholesterol, fat, blood cells and more that can narrow or block arteries. Vulnerable plaque, when found, is often a warning sign for a sudden cardiac event. More than half a million Americans die from such events each year, DeFrance said.

"Vulnerable plaques ... Are the ones that when they tear or rupture, those cause heart attacks," DeFrance said. Stable, or calcified, plaque is less harmful, though it may cause chest pain and narrow the heart's arteries.

Expanding access to cardiac CT angiograms

Cardiac CT angiograms were first used in the early 2000s, said DeFrance, and the past decade has seen an increase in their use. He himself has founded the Society of Cardiovascular CT and trained thousands of physicians on the technology. In 2022, the American College of Cardiology issued guidelines recommending cardiac CT angiography as an evaluation tool for patients complaining of chest pain.

For Kim and Matt Mischo, expanding access to cardiac CT angiograms is personal. Matt Mischo believed he was in perfect health, but Kim, who worked in health care administration, convinced him to get a cardiac CT angiogram after she tested the technology herself during a work trip. She was worried about his family's history of heart disease, even as he insisted he was in good health and had never had any worrying cardiac exams before. Finally, the active husband and father of four underwent the test — and found that he was on the verge of a massive heart attack, with large blockages in multiple key arteries.

Kim and Matt Mischo demonstrate the use of a cardiac CT angiogram scanner. Clear Heart and Lung Imaging

"I thought I was always invincible," Matt Mischo told CBS News. The news made him scramble to book an appointment with a cardiologist, and he was warned he might need open heart surgery and as many as three stents to avoid a major heart attack. Luckily, he was able to remove the plaque with an atherectomy, a minimally invasive procedure where plaque is removed with a catheter. The experience inspired the couple to open their own imaging center.

Since June, the Clear Heart and Lung Imaging Center has seen more than 300 patients. Kim Mischo estimated that of those hundreds, about 40% have found they had "some level of coronary artery disease." DeFrance works at the center, helping review the images taken and developing treatment plans for patients.

"The number one killer now, worldwide, is cardiovascular disease," DeFrance said. "Our current workup doesn't catch most people ... Our current paradigm is missing a lot. Working towards prevention, identifying the disease early so we have many more options, is crucial."

Imaging The Heart: The New Frontier

Chest pains, heart flutters, heart attack -- they are the signposts of heart troubles. In the past, such symptoms might mean a treadmill stress test or a cardiac catheterization to diagnose the problem.

That's changing with the advent of new imaging technology: CT scans, MRI, 3-dimensional echocardiography (3-D echo), and PET/CT.

"It's a new era we're at the tipping point right now," says Robert M. Steiner, MD, FACC, director of cardiac and pulmonary imaging at Temple University Health System in Philadelphia.

The traditional stress test shows the heart's function and how it performs under exertion such as walking on a treadmill or pedaling a stationary bike. In cardiac catheterization (cardiac cath), the cardiologist can examine the valves, arteries, and chambers via the use of contrast dye and a catheter inserted into the groin or arm.

But with the new imaging technology, "we can now get much the same information as we could with the [older] tests -- and do it much less invasively," Steiner tells WebMD.

"All these new tests examine function and anatomy beautifully. They are easier to perform, and often less expensive," Steiner says. "And because they are less invasive, they are easier on the patient."

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