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Elucid Bioimaging, Inc. has announced a final rule from US Centers for Medicare & Medicaid Services (CMS) that it says will 'significantly' increase the reimbursement for cardiac computed tomography angiography (CCTA).
The new rule, which goes into effect January 1, 2025, will double the amount paid to hospitals and outpatient clinics who perform cardiac CT scans from 175 USD to 357.13 USD, allowing more hospitals, particularly those in non-urban areas, to be able to offer this service, reducing disparities in care.
The increase comes after six years of advocacy work by the Society of Cardiovascular Computed Tomography (SCCT) and is due to a reclassification of CCTA into a higher ambulatory payment classification (APC) as part of the CY25 Hospital Outpatient Prospective Payment System (HOPPS) final rule.
Payment rates for the CY 2025 OPPS/ASC final rule were based on claims with dates of service between January 1, 2023, and December 31, 2023, processed through June 30, 2024, and is better reflective of the value CCTA provides in cardiac care says Elucid. In addition, CCTA prominence has increased dramatically in recent years due to the evidence-driven inclusion of CCTA as the only level 1A guideline for stable chest pain in the 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain and continuously expanding database of clinical evidence showing the efficacy of CCTA in research settings and clinical practice.
This reimbursement increase for CCTA follows recent decisions from five of the seven Medicare Administrative Contractors (MACs) to provide coverage for AI-enabled quantitative coronary plaque analysis, expanding accessibility to over 70 percent of eligible Medicare patients across the United States.
The company says these decisions recognise the importance of new technologies like Elucid’s PlaqueIQ that can help non-invasively quantify and classify coronary artery plaque and its components such as lipid-rich necrotic core (LRNC), giving potential insights into high-risk plaques that are key drivers of risk of heart attack and stroke. In addition, use of the software has the potential to enable earlier identification of higher-risk plaque before presence of symptoms or major adverse events.
“We are pleased to hear the final decision, aligning Medicare reimbursement more appropriately with the value CCTA provides in identifying and combating cardiovascular disease. We believe this could help bring CCTA and novel, impactful technology like PlaqueIQ to more patients,” said Kelly Huang, PhD, CEO of Elucid.
“Elucid is a proud supporter of SCCT, who has worked incredibly hard to advocate for reimbursements that would make CCTA more economically viable for outpatient and ambulatory care. We also are grateful to CMS, the American College of Cardiology (ACC), and the American College of Radiology (ACR) for their longstanding work to increase payment that more appropriately covers the costs of performing cardiac CT. The momentum in coverage of technologies to help clinicians better identify and risk stratify cardiovascular disease could help save lives and improve treatment pathways.”
Elucid’s FDA-cleared PlaqueIQ is the first FDA-cleared non-invasive image analysis software that can quantify and classify plaque morphology based on ground-truth histology, the gold standard for characterisation of plaques. PlaqueIQ is designed to give physicians new, clinically validated information to help stratify patients and inform patient-specific treatment pathways.
Cardiovascular disease (CVD) is the most common cause of death and disability globally, largely driven by myocardial infarction (MI) and ischemic stroke caused by atherosclerosis (plaque build-up and rupture in the arteries). The cost of CVD in the U.S. alone is approximately 219 billion USD per year, which includes the cost of healthcare services, medications and premature death. Moreover, the total cost of CVD is estimated to more than triple for people over 80 and more than double for people ages 65 to 79 by 2035.
