CMS to Assign a New Technology Payment Classification to the HeartFlow FFRct Analysis
November 6, 2017—HeartFlow, Inc. announced that the Centers for Medicare & Medicaid Services (CMS) has finalized a new technology ambulatory payment classification (APC) for the company's fractional flow reserve with computed tomography (FFRct) technology. The HeartFlow FFRct analysis is a noninvasive technology that helps clinicians diagnose and treat patients with suspected coronary artery disease (CAD).
Under the APC payment system, hospitals enrolled in Medicare that bill CMS for the HeartFlow FFRct analysis for Medicare patients will be eligible for reimbursement at a rate of $1,450.50 for the technical component of the test. This payment rate will take effect on January 1, 2018.
In the company's announcement, Pamela Douglas, MD, commented, “CMS’s decision to assign a new technology APC for FFRct technology for Medicare recipients is a recognition of the value of this technology and its demonstrated ability to reduce the number of invasive diagnostic coronary angiography procedures and help medical centers reduce costs. The HeartFlow analysis is an important tool in helping us assess patients with suspected CAD and better understand how their coronary blockages affect blood flow to the heart.” Dr. Douglas is Ursula Geller Professor for Research in Cardiovascular Disease in the School of Medicine at Duke University in Durham, North Carolina, and Past President of the American College of Cardiology.
Daniel Simon, MD, added, “The decision by CMS will help in the diagnosis and treatment of patients with suspected CAD and means the number of patients over age 65 who will have access to this technology will significantly increase. At our center, the use of the HeartFlow FFRct analysis is transforming how we diagnose and treat patients with CAD, helping us move closer to achieving the triple aim of improving the patient experience, improving the health of our patients, and reducing health care costs at our institution.” Dr. Simon is President, University Hospitals Cleveland Medical Center, and Professor of Medicine at Case Western Reserve University School of Medicine in Cleveland, Ohio.
The company noted that the American Medical Association previously issued a set of category III current procedural terminology (CPT) codes for the HeartFlow FFRct analysis that provide evidence that the analysis is a unique and distinct procedure that provides important and actionable clinical information above and beyond that of a coronary CT angiogram. Beginning on January 1, 2018, hospitals utilizing the HeartFlow FFRct analysis will be able to generate claims when it is ordered for patients with suspected CAD via the use of specific CPT codes.