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
Related News
•HealthExec
Mayo Clinic Sued Over Alleged AI Improprieties and Whistleblower Retaliation
A former Mayo Clinic research director sues the institution, alleging retaliation after raising concerns about improper AI use affecting patient safety and data integrity.
•Radiology Business
Use of Generative AI in Radiology Manuscripts Surges, Raising Integrity Concerns
Disclosure of generative AI usage in radiology manuscript writing has more than doubled in recent years, prompting editorial caution about scientific integrity.
•Radiology Business
Framework Assesses Real-World Financial Impact of Radiology AI Adoption
A new analysis presents a financial calculator for objectively assessing the return on investment (ROI) of implementing radiology AI solutions.