Reimbursement Resources

CCTA Reimbursement Has Been Increased

CMS has approved an elevated Ambulatory Payment Classification (APC) for Coronary CTA (CCTA), doubling reimbursement in the hospital setting and increasing payments in the Physician Fee Schedule (PFS) setting.
 
CCTA is the recommended first-line pathway for diagnosing patients with suspected coronary artery disease (CAD). This increase to reimbursement reflects CMS’s understanding of the superior efficiency and effectiveness of the patient pathway. The change in reimbursement more appropriately reflects the value CCTA provides in cardiac care and will help make this technology more widely available.

Hospital Outpatient: OPPS Final Rule

CY 2024
Final Rule
CY 2025
Final Rule
% change
CCTA $175
APC 5571
$357
APC 5572
+104%
FFRCT
APC 5724
$997 $1,017 +2.0%
Plaque
APC 1511
$950 $950 ---

Physician Office: PFS Final Rule

CY 2024
Final Rule
CY 2025
Final Rule
% change
CCTA $285 $318 +12%
FFRCT $888 $839 -5.8%
Plaque Set by MACs Set by MACs ---

Note: Global Rates for PFS Setting.

Ensuring Patient Access - An Established Reimbursement Pathway

The HeartFlow FFRCT Analysis is the first non-invasive diagnostic tool that aids clinicians in determining, vessel by vessel and lesion by lesion, both the extent of an artery’s narrowing and the impact that each narrowing has on blood flow to the heart.
 
By non-invasively identifying which patients, vessels, and lesions do and do not need intervention, clinicians can optimize appropriate use of invasive testing, reduce healthcare system costs and improve patient quality of life.

FFRCT Receives Category I CPT® Code

The American Medical Association (AMA) released new coding guidance for FFRCT Category I code (CPT® 75580). FFRCT must augment physician decision making and requires FFRCT values, interactivity, lesion-by-lesion interrogation, and targeting.
 
Be confident that HeartFlow’s FFRCT Analysis allows you to enable patient care compliantly.

Helping to Achieve the Triple Aim

Improve the:

Health of Populations

Experience of Care

Per Capita Costs of Care

Questions?

For more information, please contact our reimbursement representatives at

REFERENCES

1 Douglas, et al. Eur Heart J. 2015.

2 Hlatky, et al. J Am Coll Cardiol. 2015.

3 Douglas, et al. J Am Coll Cardiol. 2016.

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If you would like to request to have the HeartFlow Analysis available at a location near you, please submit your information below with details of the institution. We will share this information with the institution, but it will not guarantee HeartFlow will become available.

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HeartFlow FFRCT 分析は、有資格の臨床医による臨床的に安定した症状のある冠状動脈疾患患者への使用を目的とした個別化された心臓検査です。 HeartFlow Analysis によって提供される情報は、資格のある臨床医が患者の病歴、症状、その他の診断検査、および臨床医の専門的判断と組み合わせて使用​​することを目的としています。

ハートフロー分析に関する追加の適応情報については、次のサイトをご覧ください。www.heartflow.com/indications.

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The HeartFlow FFRCT Analysis is a personalized cardiac test indicated for use in clinically stable symptomatic patients with coronary artery disease by qualified clinicians. The information provided by the HeartFlow Analysis is intended to be used by qualified clinicians in conjunction with the patient’s history, symptoms, and other diagnostic tests, as well as the clinician’s professional judgement.

For additional indication information about the HeartFlow Analysis, please visit www.heartflow.com/indications.

If you have additional questions, close out of this message to complete our form or call our support team: 877.478.3569.

Please use our online submission form on the Clinical Research Page to apply for research grants.

Thank you for your interest!

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Campbell Rogers, M.D., F.A.C.C.

Executive Vice President and Chief Medical Officer

Campbell brings a wealth of experience to HeartFlow, where he serves as the Chief Medical Officer. Prior to joining HeartFlow, he was the Chief Scientific Officer and Global Head of Research and Development at Cordis Corporation, Johnson & Johnson, where he was responsible for leading investments and research in cardiovascular devices. Prior to Cordis, he was Associate Professor of Medicine at Harvard Medical School and the Harvard-M.I.T. Division of Health Sciences and Technology, and Director of the Cardiac Catheterization and Experimental Cardiovascular Interventional Laboratories at Brigham and Women’s Hospital. He served as Principal Investigator for numerous interventional cardiology device, diagnostic, and pharmacology trials, is the author of numerous journal articles, chapters, and books in the area of coronary artery and other cardiovascular diseases, and was the recipient of research grant awards from the NIH and AHA.

He received his A.B. from Harvard College and his M.D. from Harvard Medical School.

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