SCCT highlights payment gains, policy challenges as coronary CT use surges
Coronary computed tomography angiography (CCTA) continues to gain momentum as clinical guidelines expand its use. Seeing that reimbursement keeps pace with the technology remains a top priority for the Society of Cardiovascular Computed Tomography (SCCT), according to Ahmad M. Slim, MD, FSCCT, chair of the SCCT Health Policy and Practice Committee. He shared his perspective on the topic during a "CCTA State of the Union" business presentation at SCCT2026, SCCT's annual meeting.
Slim outlined the organization's recent advocacy successes with the Centers for Medicare and Medicaid Services (CMS) while warning that additional work is needed to secure long-term payment stability and support emerging artificial intelligence (AI) applications.
One of SCCT's biggest victories came when CMS temporarily reclassified hospital outpatient CCTA procedures into a higher-paying ambulatory payment classification (APC). Slim said the previous payment category treated cardiac CT like a routine radiology exam, reimbursing hospitals less than $200 for studies that often cost more than twice that amount because of medication administration, patient monitoring and specialized clinical staff.
SCCT successfully argued that CCTA should be recognized as a more complex cardiovascular procedure. The temporary APC reassignment is scheduled to remain in place for three years while hospitals submit sufficient claims to justify making the change permanent.
"We went from zero adoption to 23% adoption in the first year," Slim said. "Our goal is to get to 50% adoption."
He said SCCT is conducting educational campaigns aimed not only at physicians and hospital executives, but also revenue cycle teams responsible for submitting claims under the correct billing category.
The reimbursement outlook improved further with CMS's recently released Outpatient Prospective Payment System (OPPS) proposal, which includes roughly a 12% payment increase for CCTA.
Slim said the increase reflects a growing recognition of coronary CT's expanding role in patient care, driven by clinical guidelines that now recommend CCTA as a first-line imaging test for many patients with chest pain.
Policy changes coincide with rapid growth and utilization of CCTA
"We saw almost a 200% uptick in use in the last year," Slim said.
He attributed that growth to improved reimbursement, broader guideline recommendations and increasing evidence that CCTA reduces unnecessary invasive coronary angiography while helping identify patients who truly need intervention. He also noted the modality's expanding role beyond coronary artery disease, including structural heart disease and electrophysiology procedural planning.
Despite the positive developments, Slim expressed concern over CMS's ongoing 2.5% Medicare physician payment efficiency adjustment, which is applied every three years. He said repeated reductions without accounting for inflation or rising practice costs are unsustainable.
"You cannot have a 2.5% reduction in perpetuity," he said.
SCCT supports pending federal legislation that would pause the payment cuts while policymakers reassess the methodology.
Slim also discussed payment policies for newer AI-enabled cardiac CT technologies. CT-derived fractional flow reserve (CT-FFR) and AI-based plaque analysis have achieved Category I Current Procedural Terminology (CPT) status, while fat attenuation index (FAI) analysis remains a Category III tracking code as evidence and adoption continue to grow.
CMS also has proposed new APC categories specifically for emerging technologies, which Slim said could become the primary reimbursement pathway for AI-enhanced imaging applications in the future.
Looking ahead, Slim said another major policy issue is CMS's continued push toward site-neutral payments and greater use of ambulatory surgery centers and outpatient imaging facilities.
Rather than returning to traditional physician-owned private practices, he expects healthcare to evolve toward joint venture models where hospitals and physicians share financial risk while expanding access to cardiovascular services closer to patients' homes.
"As we move toward value-based care, this is probably the journey we're heading toward," Slim said. "A shared-risk model between physicians and hospital systems."
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]