On Demand: Optimize Your CCTA & Heartflow Program for Reimbursement Success in 2026-Presentation Slides

Presentation Slides

Pdf Summary

This Heartflow presentation provides a comprehensive overview and strategic guidance on optimizing reimbursement for the Coronary Computed Tomographic Angiography (CCTA) and Heartflow pathway in 2026, aligned with new CMS final rules.<br /><br />Heartflow’s platform integrates CCTA, FFRCT (Fractional Flow Reserve derived from CT), and AI-enabled Plaque Analysis to improve diagnosis and management of coronary artery disease (CAD). Over 1,400 institutions use the Heartflow Pathway, supported by Medicare and commercial payers covering FFRCT with Level 1 CPT codes and evolving coverage for Plaque Analysis.<br /><br />Significant 2026 updates include the conversion of AI Coronary Plaque Analysis (AI-CPA) from Category III to Category I CPT code 75577, effective January 1, 2026, eliminating prior Category III codes and adding work RVUs. Medicare and major payers like UnitedHealthcare, Humana, and Cigna affirm coverage for AI-CPA under defined clinical criteria: symptomatic patients at intermediate CAD risk with CAD-RADS 1-3 and negative or inconclusive acute coronary syndrome results.<br /><br />The presentation underscores the critical importance of understanding and optimizing payer landscapes, utilizing cardiology revenue codes (048x) instead of restrictive radiology codes to maximize reimbursement. CMS removed revenue code restrictions for CCTA, FFRCT, and AI-CPA, allowing hospitals to choose appropriate codes aligned with cardiology cost centers for better cost-to-charge ratio calculations and stable payment.<br /><br />Best practices include managing prior authorizations internally, ensuring clinical documentation (cCTA reports) is readily available, and using precise diagnosis codes related to CAD symptoms to avoid denials. Payers may require specific data like CAD-RADS scores for authorization.<br /><br />Finally, health systems are advised to review revenue codes and chargemasters annually, select fair market charges, and engage payers proactively to secure and maintain coverage. Collaboration with payers, physicians, and revenue cycle teams is vital to ensure patients benefit from these diagnostic advances while maintaining financial viability for providers. The session closes with contact information for reimbursement inquiries and a Q&A.

Keywords

Heartflow

Coronary Computed Tomographic Angiography

CCTA

FFRCT

AI Coronary Plaque Analysis

CMS final rules 2026

Medicare reimbursement

Cardiology revenue codes

CAD-RADS

Prior authorization management