Significant Increase to CMS Reimbursement for CCTA

By: ​Teri Bedard, RT(R)(T), CPC

​In 2006, the AMA’s CPT® Editorial Panel established six Category III CPT® codes to describe cardiac computed tomography angiography with contrast materials (cardiac CT services) effective January 1, 2006. In 2010, the six codes were replaced with three Category I CPT® codes, 75572, 75573, and 75574.  The three codes have been paid in alignment with the HOPPS payment rate methodology based on geometric mean cost, ranging from $175-$265 from CY 2015 through CY 2024.

​CCTA CMS Reimbursement Increase

​CMS continued to receive comments from stakeholders indicating the assigned payment rates had declined since 2017 and no longer cover the cost of providing the services. CMS had also received comments to allow CPT® codes 75572, 75573, and 75574 to be submitted under different revenue codes as appropriate. Current reporting requires use of revenue codes CT scan (035X) and Radiology Diagnostic (032X), and commenters indicated MACs have applied edits to the cardiac CT codes preventing hospitals from reporting a cardiology (048X) revenue code when appropriate.  CMS did clarify that Chapter 4 of the Medicare Claims Processing Manual does not instruct hospitals which revenue code each service must be billed under; this is determined by the hospital and related to the assigned costs.

In 2023, CMS removed a revenue code edit to allow cardiac CT codes to be billed with any appropriate revenue code by the hospital. CMS believes the previous edit prevented reporting of cardiology revenue code (048X), which maps to cardiology cost center (03140) when billing for the cardiac CT services. Many stakeholders felt the inability to report services appropriately  resulted in lower revenue because the services were in a lower cost center.

Due to  these circumstances, CMS posted a Request for Information (RFI) about cardiac CT services and the corresponding billing practices. CMS indicated they received a significant number of comments for the RFI. Many of the concerns expressed that even with the revenue code edit removed for CY 2024, there were still a significant number of procedural and logistical hurdles to adjust to the new revenue code reporting. 

​After review, CMS determined that if there had not been edits in place, and 50 percent or more of hospital outpatient departments billed for the services with the cardiology revenue code, the geometric mean cost would have increased, resulting in a higher APC placement. CMS finalized for CY 2025 to move CPT® codes 75572, 75573, and 75574 from APC 5571 ($178.02) to APC 5572 ($357.13).

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CPT® Code	Long Descriptor	Proposed CY 2025 APC	Proposed CY 2025 SI	Final CY 2025 Rate APC 5571	Final CY 2025 APC	Final CY 2025 SI	Final CY 2025 Rate APC 5572
75572	Computed tomography, heart, with contrast material, for evaluation of cardiac structure and morphology (including 3D image postprocessing, assessment of cardiac function, and evaluation of venous structures, if performed)	5571	S	$178.02	5572	S	$357.13
75573	Computed tomography, heart, with contrast material, for evaluation of cardiac structure and morphology in the setting of congenital heart disease (including 3D image postprocessing, assessment of left ventricular (LV) cardiac function, right ventricular (RV) structure and function and evaluation of vascular structures, if performed)	5571	S	$178.02	5572	S	$357.13
75574	Computed tomographic angiography, heart, coronary arteries and bypass grafts (when present), with contrast material, including 3D image postprocessing (including evaluation of cardiac structure and morphology, assessment of cardiac function, and evaluation of venous structures, if performed)	5571	S	$178.02	5572	S	$357.13

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Key Takeaways
This significant policy change is a win for providers offering Cardiac CT services, but it also comes with a critical requirement for receiving this increased reimbursement: accurate documentation and coding.

To help providers stay ahead, RCCS offers a range of cardiology educational products, including Navigator® Coding Guides, designed to support accurate and efficient coding practices. These resources are essential for navigating 2025’s changes and maximizing your revenue potential.

Learn more and equip your team with the tools they need!

Cardiology Educational Products

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Disclaimer: CPT® codes and descriptions are copyrighted 1995-2004 by the American Medical Association (AMA). All rights reserved.