On Demand: 2025 Updates on Billing and Reimbursement for CCTA and Plaque Analysis-Presentation Slides

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The document offers detailed insights into updates for billing and reimbursement strategies for Coronary Computed Tomography Angiography (CCTA) and plaque analysis, slated for 2025 and beyond. Experts from Cleerly, University of Washington, and 4Front Strategic Partners aim to enhance diagnostic precision via AI-enabled solutions. These solutions offer a comprehensive platform for assessing coronary artery disease (CAD), characterizing and quantifying atherosclerosis, stenosis, and ischemia. The advanced imaging methodologies surpass traditional options like SPECT and FFRCT due to their higher diagnostic and prognostic utility.<br /><br />Significant emphasis is placed on the reimbursement framework for CCTA and plaque analysis, covering HCPCS and CPT codes, which are crucial for billing and payment. New CPT codes for AI-QCT/AI-CPA will become effective from January 1, 2026, following their phased policy integration. Cleerly's platform provides clinically-actionable findings with its AI technologies facilitating detailed, quantitative data curation at multiple levels—patient, vessel, and lesion, supporting better clinical decision-making.<br /><br />Coverage for these diagnostic tools is conditional upon meeting specific criteria, like being applicable for patients with chest pain but no known CAD, and certain classification levels like CAD-RADS 1-3. However, limitations exist if used purely for screening or in conjunction with invasive procedures. Notably, it details Medicare's policies and outlines coverage criteria and payment structures, with adjustments based on CPT code changes.<br /><br />The document further explains the processes and responsibilities involved with AMA and CMS in determining reimbursement rates, verifying coding accuracy, and analyzing relevant data to reflect service complexity effectively. To ensure a seamless transition to new codes, payers are urged to update their systems to align with these advancements promptly. Finally, it outlines the best approaches to appeals when coverage is declined, emphasizing stakeholders' roles in enacting change.

Keywords

Coronary Computed Tomography Angiography

CCTA

billing strategies

reimbursement

AI-enabled solutions

coronary artery disease

CPT codes

HCPCS

diagnostic precision

atherosclerosis