CMS Assigns Payment Rate for New Procedure Code for Automated Quantification, Characterization of Coronary Atherosclerotic Plaque

The Centers for Medicare and Medicaid Services (CMS) recently assigned a Current Procedural Terminology (CPT) code for automated quantification and characterization of coronary atherosclerotic plaque.

This additional CPT code supports quantitative imaging and aligns with the mission and goals of the RSNA Quantitative Imaging Biomarkers Alliance (QIBA).

On September 9, CMS released the October 2022 update of the Hospital Outpatient Prospective Payment System (OPPS). In this OPPS update, CMS assigned a payment rate of $900-$1000 for the automated (computerized) quantification and characterization of coronary atherosclerotic plaque to assess severity of coronary disease, using data from coronary computed tomographic angiography CPT code.

Payment for the new Level III code—the first to provide reimbursement for computerized coronary plaque quantification and characterization—became effective October 1, 2022.

The reimbursement associated with the performance of advanced, computerized quantification is in addition to the current Level I reimbursement for the clinical performance and interpretation of coronary computed tomography angiography (CCTA), where plaque quantification and characterization is typically done in a semi-quantitative, subjective manner.

Quantitative Imaging Provides Superior Risk Assessment, Disease Progression Tracking

“Quantitative imaging biomarkers with high repeatability and reproducibility are one way to provide improved patient care and lower the cost of health care,” said QIBA chair, Timothy J. Hall, PhD, professor in the Departments of Medical Physics and Biomedical Engineering at the University of Wisconsin.

Quantitative imaging is the extraction of quantifiable features from medical images for the assessment of normal or the severity, degree of change, or status of a disease, injury or chronic condition relative to normal.

Listen as Dr. Hall discusses QIBA and how it can transform patient care.