Higher payments for CCTA could bring considerable change to cardiology

Blankstein said the CMS proposal presents a "unique opportunity" to rectify what he describes as a decade-long error in the reimbursement structure for cardiac CT. 

Details of the proposed change in CMS CCTA payments

The recently released 2025 Medicare Hospital Outpatient Prospective Payment System (HOPPS) proposed rule might raise Medicare reimbursement for CCTA from $175 to $386 by moving it to a new ambulatory payment classification (APC). 

Historically, Medicare Administrative Coordinators (MACs) restricted hospitals to using the radiology CT revenue code (0350) for CCTA instead of the higher-paying cardiology code (0480). SCCT said CMS addressed this issue via a transmittal earlier this year, but other payer and clearinghouse edits still require the CT revenue code, preventing the use of the cardiology revenue code.

CMS is seeking comments to ascertain whether 50% or more hospital outpatient departments are using, or have attempted, or would use a revenue cardiology code for CCTA tests if allowed.

Changing CCTA APC level would account for it being a more advanced imaging test

At the heart of the issue is the categorization of cardiac CT within CMS’s APC system, which groups tests based on the resources they require. Cardiac CT is currently classified as an APC level 1 test, alongside simpler procedures, which results in lower reimbursement. Blankstein and leading organizations, including the American College of Cardiology (ACC), American College of Radiology (ACR) and SCCT, have advocated for reclassifying cardiac CT as a level 2 test, which would align payments more closely with the actual costs.

In addition to reclassification within the APC system, Blankstein highlighted the need for hospitals to change the revenue codes they use when billing for cardiac CT. Currently, hospitals must submit charges under general radiology or CT revenue codes, which undervalue the procedure. The proposed CMS changes would allow hospitals to use cardiology-specific revenue codes, potentially leading to higher payments. However, there were some barriers to billing under cardiology versus radiology. 

"What CMS is now saying is they want to hear from hospitals and if they hear that more than 50% of cardiac CT exams potentially could be charged under a different revenue code, they are willing to entertain moving cardiac CT to a different APC. So what this means is, hospitals need to share their experience with CMS about which revenue code they're using and why they haven't switched to cardiac CT revenue codes," Blankstein explained. 

He said hospitals responding to CMS should describe some of the obstacles they face, and at least express that they have an interest in switching cardiac CT charges to a different revenue code.

Cardiac CT scans are reimbursed as much as a hand X-ray

Currently, the technical fee that hospitals receive from CMS for performing a cardiac CT is under $200, a figure that pales in comparison to the actual costs of the procedure. 

"Doing cardiac CT is expensive. You need a contemporary scanner, advanced technologists, special software, and patient monitoring—similar to what’s required for a stress test," Blankstein explained. 

He added that, alarmingly, a contrast-enhanced CT scan is currently reimbursed at the same rate as a much less technical X-ray of the hand.

Resources used may determine if CCTA can be billed under radiology or cardiology

"One thing that sometimes confuses folks is the fact that cardiac CT is read by both cardiologists and radiologists, and the revenue code that you submit has nothing to do with whether cardiac CT in your hospital is performed by cardiologists or radiologists," Blankstein said.

There could be radiologists who perform stress tests and submit revenue codes under cardiology revenue code and vice versa, he said; the resources used will determine the revenue code. 

"I think that's an important point. I don't think we should fall in the confusion of whether the CT is provided by a cardiologist or radiologist. And certainly both cardiologists and radiologists can do this test and do it very well in regardless of where the test actually sits or who actually reads it. All of us need to work together on improving the reimbursement for this," he explained. 

SCCT, which has been one of the biggest advocates for cardiac CT and this new reimbursement change, has a membership of around 6,000, which is split about evenly between radiologists and cardiologists. 

Low payments are holding back cardiac CT programs

Blankstein said there are barriers to starting or expanding cardiac CT programs, mainly due to the costs related to buying newer CT scanners, software and the training needed to read CCTA exams. He said these barriers could be offset if payments were higher, but current reimbursements do not cover the actual costs of such programs.

For these reasons, he emphasized, the potential impact of this CMS proposal is significant. Blankstein explained that if reimbursement rates are adjusted to better reflect the costs of providing cardiac CT, more hospitals, particularly those in non-urban areas, may be able to offer this service, reducing disparities in care. 

"We don't want there to be such a big barrier to providing cardiac CT," he said, underscoring the importance of fair reimbursement in expanding access to advanced cardiac imaging.