Reimbursement for AI-based plaque assessments is improving

“A lot of data is now out there showing how CT-based plaque assessment has prognostic implications in management of patients,” Parikh explained. She added that at least 50% of patients appear to have their treatment plans changed once clinicians review the AI software's analysis. 

Private insurers are increasingly following the Centers for Medicare and Medicaid Services (CMS), which began offering payment in the past year. She emphasized that a strong signal of permanence in reimbursements is coming in early 2026.

“The good news is that the tracking code is now being transitioned to a CPT category 1 code starting January 2026. So that shows more promise as well,” Parikh said.

CCTA’s expanding role in patient pathways

With reimbursement improving, CCTA continues to shift diagnostic pathways for chest pain evaluation and invasive coronary angiography.

“It's become a class 1 indication for patients with stable chest pain as well as patients with acute chest pain who have no prior diagnosis of CAD,” Parikh said. She added that CCTA, combined with FFR-CT, is now acting as a more effective gatekeeper to the cath lab.

Hospitals adopting coronary CT protocols are also seeing efficiency improvements in emergency settings. “You get the test done within 30, 40 minutes, the patient’s out, you get a diagnosis soon,” she said

Nuclear imaging has largely served as the cath lab gatekeeper the past couple decades, but she said CCTA is increasingly favored when a rapid CAD diagnosis is required. However, she said nuclear PET still has a role because of its ability to accurately measure myocardial flow, which can also help in identifying microvascular disease.

Ongoing CCTA advocacy

Parikh noted that SCCT members, and members from other groups such as the American College of Cardiology, play a critical role in broadening insurer adoption. 

“I think there's always an open call from CMS to get feedback. That's a good time to start writing letters to CMS,” she said. “You have to advocate for your patients."

Strong evidence base for CCTA is paying off

Years of clinical research underpinning AI-based plaque assessment are now yielding tangible policy results. “A lot of research has been happening, both prospective and retrospective, new trials are coming out,” Parikh said, citing major studies such as SCOTT HEART, PROMISE, TRANSFORM, and the Heartflow DECIDE Registry. “We're continuously seeing new data emerge and it's showing a lot of promise.”

With CMS reimbursement in place, an imminent Category I CPT code, and private insurers increasingly aligning, SCCT’s advocacy appears to be clearing the path for broader use of AI-enhanced CCTA—potentially transforming how coronary artery disease is assessed and managed nationwide.