ASNC calls on members to fight 57% Medicare cut for cardiac amyloid imaging
The American Society of Nuclear Cardiology (ASNC) is calling on its members to mobilize against a proposed 57% reduction in Medicare reimbursement for cardiac amyloidosis imaging set to take effect in 2026.
ASNC President-elect Jamieson M. Bourque, MD, MHS, medical director of nuclear cardiology, echocardiography and the stress laboratory at UVA Health, said the proposal could severely restrict patient access to a life-saving diagnostic tool.
“We were dismayed when we saw that there was a proposed 57% cut with a code that is used for SPECT imaging in cardiac amyloidosis with pyrophosphate or HDP,” Bourque told Cardiovascular Business. “This is going to have a highly negative impact, not only in nuclear cardiology, but also on patients who are being evaluated for cardiac amyloidosis, an extremely morbid disease with effective therapies.”
The reduction stems from a CMS decision to reassign CPT code 78803, which covers SPECT imaging for amyloidosis, to a lower-paying Ambulatory Payment Classification (APC). This is due to non-cardiology tracers being bundled into the same category and then pulled out of the data after a new policy reclassified them.
Currently, hospitals are reimbursed about $1,300 per exam. Under the proposed change, that figure would drop by more than half to approximately $558. Bourque said that such cuts would make it difficult for hospitals and labs to justify dedicating busy SPECT cameras and staff time to lengthy amyloid imaging studies.
“Most labs are doing imaging at two or three hours, and that’s a lot of time for a patient to be on the camera and in the lab,” Bourque said. “It’s critically important that the time and effort be appropriately reimbursed.”
The timing of the cut is especially concerning, Bourque noted, as demand for cardiac amyloidosis imaging is growing. New therapies for transthyretin amyloid cardiomyopathy (ATTR-CM) are changing the outlook for patients, driving earlier and more frequent screening. The earlier a drug therapy can be started, the less damage is caused to the heart. Nuclear imaging is increasingly used not only for diagnosis, but also to track disease progression and monitor response to therapy. He said the disease was once thought to be a rare disease, but it with a therapy available, interest in screening patients has risen and more patients are being found that originally thought were out there.
“It’s critically important that we identify patients as early as possible,” Bourque said. “With multiple treatments available, there is going to be increased need to use testing to monitor disease progression and response to therapy.”
ASNC has issued an urgent call to action, urging members to contact their lawmakers and CMS to oppose the proposed reimbursement change. The society’s advocacy committee is also working to provide policymakers with data on how the cut could limit access to care.
“This is a disorder that is underdiagnosed, and we need to do more imaging—not less,” Bourque said. “We are strongly advocating for a reversal of that proposal.”
Learn more about nuclear cardiology's key role in cardiac amyloidosis
Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: [email protected]