medicare to double reimbursement for cardiac computed tomography angiography services

Elucid Bioimaging, Inc. has announced a significant increase in reimbursement for cardiac computed tomography angiography (CCTA) following a final rule from the U.S. Centers for Medicare & Medicaid Services (CMS).

Reimbursement Increase for CCTA

Starting January 1, 2025, the reimbursement rate for CCTA will double from $175 to $357.13. This change is expected to improve access to cardiac CT services, particularly in non-urban hospitals, and address healthcare access disparities.

Advocacy for Increase

The Society of Cardiovascular Computed Tomography (SCCT) has advocated for this increase for six years, and it is part of the CY25 Hospital Outpatient Prospective Payment System (HOPPS) final rule. The reclassification of CCTA into a higher ambulatory payment classification (APC) reflects the growing recognition of its value in cardiac care.

AI-Enabled Quantitative Coronary Plaque Analysis

The reimbursement increase aligns with the decision of five out of seven Medicare Administrative Contractors (MACs) to cover AI-enabled quantitative coronary plaque analysis, which will enhance accessibility for over 70% of eligible Medicare patients nationwide. Elucid's PlaqueIQ software, which non-invasively quantifies and classifies coronary artery plaque, plays a crucial role in this landscape. Identifying high-risk plaques before symptoms manifest could lead to earlier interventions and improved patient outcomes.

Impact on Patient Care

Cardiovascular disease (CVD) is the leading cause of death and disability worldwide, with a significant financial burden in the United States. The costs associated with CVD are projected to increase significantly for older populations. Elucid's CEO, Kelly Huang, expressed optimism about the reimbursement increase, believing it will facilitate broader access to CCTA and innovative technologies like PlaqueIQ, ultimately benefiting more patients.

Collaborative Efforts

The reimbursement increase for CCTA is the result of collaborative efforts from various organizations, including CMS, the American College of Cardiology (ACC), and the American College of Radiology (ACR). These stakeholders have worked to ensure that payment structures adequately cover the costs of cardiac CT scans. These advancements in coverage for technologies aimed at better identifying and stratifying cardiovascular disease are expected to have a profound impact on patient care, improving access to diagnostic tools and treatments and potentially saving lives.

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