Five of the seven Medicare Administrative Contractors (MACs) have published final local coverage determinations (LCDs) expanding coverage of Artificial Intelligence Enabled CT Based Quantitative Coronary Topography (AI-QCT)/Coronary Plaque Analysis (AI-CPA) for Medicare patients. The LCDs were updated to expand coverage for stable chest pain and Coronary Artery Disease Reporting and Data System (CAD-RADS) 1 category.
CAD-RADS is a standardized method to communicate findings of Coronary Computed Tomography Angiography (CCTA). It was developed as an expert consensus document by the American College of Radiology® (ACR®), Society of Cardiovascular Computed Tomography (SCCT), the American College of Cardiology (ACC), and the North America Society of Cardiovascular Imaging (NASCI). As previously reported, this is a win and one the College supports for the cardiac imaging community.
The Medicare Administrative Contractors (MACs) that published final LCDs are: WPS, Palmetto, Noridian, National Government Services, Inc. and CGS Administrators.
ACR members are urged to contact their respective MAC for reimbursement information as claims processing may take time. If you have difficulty reporting these category III CPT codes (0623T, 0624T, 0625T and 0626T) for this procedure, contact ACR and the Contractor Advisory Committee Network will investigate. The final policies and associated billing and coding articles can be accessed by searching the Medicare Coverage Database.
If you have questions or want more information about local coverage policies and activities, contact Alicia Blakey, ACR Principal Economic Policy Analyst.
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