Medicare's 2026 Physician Fee Schedule proposes a $1,000 payment and new CPT code for AI-based coronary plaque analysis software.
Key Details
- 1CMS introduces a Category 1 CPT code and $1,000 proposed payment for coronary plaque analysis AI software.
- 2Applies to solutions from Cleerly, Elucid, and HeartFlow that analyze coronary CT angiography (CCTA) images.
- 3Policy would take effect January 1, 2026 under Medicare Part B, pending finalization.
- 4Move follows recent recommendations for similar commercial coverage by EviCore.
- 52022 U.S. heart disease deaths surpassed 700,000, driving need for early detection with such AI tools.
- 6A prior CMS rule (for 2025) doubled hospital payment for cardiac CT from $175 to $357.
Why It Matters
This major reimbursement proposal signals growing acceptance and value recognition for AI-powered imaging in cardiovascular care, paving the way for wider adoption and patient access. Market entry via Medicare reimbursement is a key milestone that could accelerate clinical integration and commercial prospects for radiology-AI vendors.
Source
Radiology Business
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