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Proposed CMS Rule Could Double CCTA Reimbursement
‘All hands on deck’ required by cardiac imaging community
‘All hands on deck’ required by cardiac imaging community
Society of Cardiovascular Computed Tomography News
ARLINGTON, VA – Reimbursement for coronary computed tomography angiography (CCTA) could potentially double for U.S. hospitals and outpatient services starting next year, after being chronically and significantly under-reimbursed.
Immediate Past President Ed Nicol, MD, MBA, MSCCT of the Society of Cardiovascular Computed Tomography (SCCT) made the announcement and call to action during the opening ceremony of the Society’s 19th Annual Scientific Meeting (SCCT2024) held in Washington, DC.
“I have to say, I did catch [the news] slightly by surprise last week, but what a great thing to happen just before our conference and a great time to be able to share this with you while also asking for your help,” he added in his opening comments.
“That reimbursement level would make a huge difference to practices that struggle with cost issues and pave the way for more sites to offer cardiac CT, while still ensuring that CCTA is the most cost-efficient test. However, as mentioned in order to do this, we’re going to need your help.”
According to Nicol, Medicare has significantly under-reimbursed CCTA for years, despite it being a comparatively less costly test.
Medicare reimbursement for CCTA is currently only $175. This is because the U.S. Centers for Medicare and Medicaid Services (CMS) has grouped CCTA in the same category as general CT services, which is not appropriate for the time and effort that goes into CCTA exams and evaluation.
In order to change the categorization, the revenue code needs to change to 048x, a cardiology code that will potentially double CCTA reimbursement.
CMS seeks comments by Sept. 9 to ascertain whether 50% or more hospital outpatient departments are using, have attempted, or would use a revenue cardiology code for CCTA tests if allowed.
Current SCCT President Maros Ferencik, MD, PhD, MSCCT, described the proposed rule as the potential light at the end of a 6-year long tunnel of advocacy work that will require “all hands on deck” to pull us through it.
“Please bear in mind – and this is very important for our community, as we represent cardiology, radiology and other fields – that the use of a cardiology revenue code is not connected to how a hospital might allocate revenue of cardiac CT,” he said in the SCCT2024 closing ceremony. “It’ll really help us all – help the whole field – to get fair and sustainable reimbursement for cardiac CT."
What is the Hospital Outpatient Prospective Payment System (HOPPS) Proposed Rule?
Who this affects:
All U.S. cardiac imagers who use CCTA.
What SCCT needs:
We need our members (ideally from hospitals and practices representing at least 50% of claims) and others backing the use of the revenue code 048x to send comment letters to CMS before Sept. 9, 2024.
By sending a letter to CMS, advocating for the increased reimbursement, this generates higher awareness for the wider community and presents further information to CMS on why these rates should increase.
In addition to your letter, talk to your financial or billing administrator about the possibility of a revenue code change and encourage them to write a letter as well.
Why now?
We have been advocating for a new code for 6 years. This is the first time that CMS has expressed the willingness to change the payment rate for CCTA – in part due to a payor edit that was discovered and relayed to CMS in late 2023.
The more feedback we provide, the louder our voice can be. This is why our request to SCCT members is urgent and we need your help, even if (or maybe especially if) you've helped in the past.
SCCT has resources to help individuals and institutions to submit their comments on the society's website.
About the Society of Cardiovascular Computed Tomography
Founded in 2005, the Society of Cardiovascular Computed Tomography (SCCT) is the international professional society devoted to improving health outcomes through effective use of cardiovascular computed tomography (CCT). SCCT is a community of physicians, scientists and technologists from over 85 countries advocating for access, research, education and clinical excellence in the use of CCT. For more information, please visit https://scct.org/.
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