Elucid Commends CMS on Proposed Rule for Coronary Plaque Analysis

The proposed rule by the Centers for Medicare & Medicaid Services (CMS) marks a significant step towards broader access to innovative imaging tools that help identify high-risk cardiovascular patients earlier and more accurately. The proposed rule includes a Category I CPT code for coronary plaque analysis and a national Medicare average payment amount of over $1,000, pending the final Medicare Physician Fee Schedule (PFS) ruling, which will come out in November. This development is particularly significant given that coronary artery disease remains the leading cause of death nationwide, with over 700,000 lives claimed in 2022 alone. Elucid, an AI medical technology company, has commended CMS on this proposed rule, highlighting its potential to enhance patient outcomes and access.

Key Takeaways:

• The proposed rule by CMS includes a Category I CPT code for coronary plaque analysis, which will enable Medicare beneficiaries to access this technology.
• The national Medicare average payment amount for coronary CTA with plaque analysis is set to be over $1,000, pending the final PFS ruling in November.
• Coronary plaque analysis offers invaluable insights into plaque burden, composition, and morphology, enabling earlier and more accurate identification of high-risk patients.
• Numerous studies have demonstrated that non-invasive imaging enhances risk stratification and clinical decision-making while reducing the need for more invasive and costly diagnostic procedures.
• The proposed rule marks a significant step towards broader access to innovative imaging tools that help identify high-risk cardiovascular patients earlier and more accurately.
• Elucid CEO Kelly Huang commended CMS on the proposed rule, highlighting the potential to enhance patient outcomes and access.
• The proposed payment level of over $1,000 reflects the clinical value, technological investment, and expertise needed to perform coronary CTA with plaque analysis.

Statistics:

• Over 700,000 lives were claimed by heart disease in 2022 in the US, with nearly 1 in every 5 deaths attributed to cardiovascular disease.1
• The proposed rule includes a Category I CPT code for coronary plaque analysis and a national Medicare average payment amount of over $1,000.
• Coronary artery disease remains the leading cause of death nationwide, with over 700,000 lives claimed in 2022.

Sources:

1. American Heart Association