Reimbursement update: What hospitals need to know about new Medicare payments for cardiac CT
The American College of Cardiology (ACC) has shared a new analysis of updated payment policies for coronary computed tomography angiography (CCTA) exams. Understanding these changes is vital for hospitals looking to receive proper reimbursements for their services in 2025 and beyond.
Background context about the CCTA coding change
In November, the Centers for Medicare and Medicaid Services (CMS) included a new payment policy in the 2025 Medicare Hospital Outpatient Prospective Payment System (OPPS) final rule that more than doubled the Medicare reimbursements hospitals receive for performing CCTA. The update involved temporarily moving CCTA revenue codes 75572, 75573 and 75574 into a higher ambulatory payment classification, which increased the rate from $175 in 2024 to $357.13 in 2025.
Medical societies such as the ACC and Society of Cardiovascular Computed Tomography celebrated the news, highlighting the many years they’ve spent advocating for payment policies that better reflect the resources required to perform CCTA. Artificial intelligence specialists such as HeartFlow and Cleerly also celebrated the update; these companies have developed advanced algorithms that use CCTA results to provide detailed breakdowns of a patient’s heart health.
What billing teams need to know
The ACC detailed the key changes involved with this policy update, noting the various stakeholders involved in ordering, performing and billing CCTA exams should work together to ensure everyone is on the same page.
“Given the temporary status and data dependency of this change, it is imperative that hospital revenue cycle and billing departments are educated on this change and bill the cardiology revenue code when appropriate,” the ACC explained.
Key takeaways from the ACC update include:
- CMS has officially removed an outdated Return to Provider edit related to CCTA exams.
- Clinical charge master databases may need to be updated to show that revenue codes for cardiac CT can be linked to codes 0489X (Cardiology – Other) or 0409x (Other Imaging Services).
- Internal hospital software may not have been properly updated, sending alerts that suggest these updated codes are not correct. “Additional effort may be needed” to update software and remove any inaccurate alerts.
- CMS will be monitoring these temporary changes for the next few years—and there is a chance things could go back to the way they were. “If CMS does not see a significant change after ‘several years,’ they will revert payment for these services to the standard OPPS payment methodology,” the group explained.
Click here for more details from the ACC about these significant payment changes.
In addition, a full webinar on the new policies with feedback from several experts can be viewed here.
Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.