AMA Issues Category I CPT Code for AI-Enabled Plaque Quantification Technology

October 18, 2024—HeartFlow, Inc., a developer of noninvasive artificial intelligence (AI) heart care solutions, announced that the American Medical Association (AMA) has issued a new Category I Current Procedural Terminology (CPT) code for AI-enabled plaque quantification technology, including the company’s HeartFlow Plaque Analysis, effective January 2026.

The company noted that the AMA issued the new code in response to increased use of AI-enabled plaque quantification technology like the HeartFlow Plaque Analysis and strong clinical evidence supporting its value.

According to HeartFlow, a Category III CPT code and payment were previously granted for Plaque Analysis in 2021. Along with the transition to a Category I code, the Centers for Medicare & Medicaid Services will establish relative value units for Plaque Analysis, which provides payment to physicians for performing the service.

The successful conversion to a Category I code indicates that AI-enabled plaque quantification is considered consistent with current medical practice.

The new reimbursement code complements the recently announced favorable coverage decision by four of seven Medicare Administrative Contractors, which will begin covering HeartFlow Plaque Analysis on November 24, 2024, advised the company.

“We commend the AMA’s issuance of this upgraded Category I CPT billing code, which validates the technology’s clinical value in quantifying and characterizing plaque to help assess risk and personalize treatment for patients with coronary artery disease,” commented Campbell Rogers, MD, Chief Medical Officer of HeartFlow, in the press release. “It has been shown that with HeartFlow’s Plaque Analysis, two out of three patients had their medical management changed and more precisely tailored, which could contribute to better treatment decisions and improved outcomes.”