CMS Updates Coverage for AI Coronary Plaque Analysis

October 15, 2024—The Society of Cardiovascular Computed Tomography (SCCT) announced that four of the seven Medicare Administrative Contractors (MACs) released final local coverage determinations (LCD) for artificial intelligence (AI) coronary plaque analysis (AI CPA).

According to SCCT, the contractors for the United States Centers for Medicare & Medicaid Services (CMS) provided updated LCDs for current procedural terminology (CPT) codes 0623T–0626T. The LCDs have an effective date of November 24, 2024.

The four MACs are CGS, National Government Services, Palmetto GBA, and Wisconsin Physicians Service Insurance Corporation.

Per the new LCDs, AI CPA using coronary computed tomography angiography (CCTA) is considered reasonable and medically necessary as a diagnostic study when the patient is eligible for CCTA; and the patient presents with acute or stable chest pain and is at intermediate risk for coronary artery disease (CAD) or has evidence of CAD-RADS level 1, 2, or 3 disease on their CCTA; and the patient is negative or inconclusive for acute coronary syndrome.

The society stated that members of the SCCT Health Policy & Practice Committee (HPPC) presented as subject matter experts during a May 2023 MAC-led Multijurisdictional Meeting on CAC Noninvasive Technology for Coronary Artery Plaque Analysis and later provided comments on the draft LCDs that helped shape the final policies.

“This is a positive step towards improved patient care,” commented Ahmad Slim, MD, a fellow of SCCT, is Chair of the HPPC. “Increased access to AI CPA, AI-augmented plaque assessment analysis tools, will help medical teams make more informed decisions for their patients, and have the potential to reduce unnecessary invasive procedures downstream.” Dr. Slim is Director of Imaging at Pulse Heart Institute in Tacoma, Washington.

Of the three remaining MACs, Noridian is expected to publish its final LCD shortly; Novitas Solutions and First Coast Service Options, Inc. continue to consider coverage for AI CPA on a case-by-case basis.

The SCCT HPPC offers tools for administrators to navigate the complex landscape of insurance plans, billing, and reimbursement on the SCCT website at scct.org, noted the society.

Three manufacturers of AI-enabled plaque quantification tools issued press releases announcing the MACs’ LCDs, which apply to their respective products: HeartFlow, Inc. with the HeartFlow Plaque Analysis; Elucid with its PlaqueIQ image analysis software; and Cleerly Inc. with the Cleerly Labs AI-QCT technology.