Revenue & Reimbursement

Healthcare reimbursement is payment that a hospital, diagnostic imaging facility, subspecialty department or healthcare providers receive for performing a service. This also includes individual radiologist or cardiologist reimbursement and billing and coding rules for submitting claims.

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Renal denervation systems from Recor Medical, Medtronic receive new outpatient payments

Both FDA-approved systems previously received inpatient payments in August. 

CMS updates outpatient reimbursement policy for Barostim device

CMS continues to show confidence in the benefits of baroreflex activation therapy with the Barostim device from CVRx. 

Medicare money payment reimbursement dollar decline george washington

CMS makes 2025 Medicare cuts official—and doctors are not happy

CMS has published its final rule for the 2025 Medicare Physician Fee Schedule, and it includes significant payment cuts. Cardiology groups have been working hard to stop these changes from going into effect since they were first proposed in July.

robot reviewing heart data

Medicare coverage expands again for AI-enabled coronary plaque assessments

Another MAC has agreed to cover the use of these advanced technologies to evaluate patients for signs of coronary artery disease. 

Georgia Lawrence, JD, with ASNC, explains how CMS uses hospital reported data to develop cardiac PET payment rates.

Understanding hospital billing for cardiac PET/CT

Significant fluctuations in PET and CT reimbursement rates have made it especially challenging to keep up with this complex topic. We spoke to an expert to learn more.

HeartFlow Plaque Analysis Example

New Category I CPT code issued for AI-enabled coronary plaque analysis software

The news comes just days after CMS confirmed these technologies would start receiving expanded Medicare coverage in November. HeartFlow and other AI vendors have already shared their excitement over the decision. 

Example of an automated artificial intelligence (AI) assessment of soft coronary plaque from a CT scan from the vendor Cleerly. The AI gives a very detailed report of all the plaque in all the coronary vessels. Some cardiology experts believe this may be the way of the future in screening patients for early coronary disease and monitoring the impact of prevention efforts such as statins to determine if more aggressive treatments are needed.

Medicare administrative contractors approve coverage of AI-enabled quantitative CT

Four of the seven Medicare Administrative Contractors (MACs) announced they will now cover artificial intelligence-enabled quantitative coronary tomography (AI-QCT) and coronary plaque analysis (AI-CPA). 

HeartFlow Plaque Analysis

CMS updates Medicare coverage for AI-powered coronary plaque assessments

The new policy goes into effect in November, improving Medicare coverage for a technology that has rapidly gained momentum in recent years.

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Around the web

Radiology Business
Key takeaways from RSNA 2024 for AI, CT, MRI and the radiology staffing shortage

Several key trends were evident at the Radiological Society of North America 2024 meeting, including new CT and MR technology and evolving adoption of artificial intelligence.

Health Imaging
Use of AI opportunistic screening in CT for cardiovascular disease

Ron Blankstein, MD, professor of radiology, Harvard Medical School, explains the use of artificial intelligence to detect heart disease in non-cardiac CT exams.