Cardiology Magazine

Editors' Corner | Steps in the Treatment of Pulmonary Embolism (Watch Out! The Staircase is Tricky!)

Cover Story | Pulmonary Embolism: A Clinical Approach

Feature | Ten Americas: Growing Disparities Creating Demographic Chasms

Feature | Bridging the Gender Gap in Heart Health: Women's Specialized Clinics

Feature | Championing Change: Herman Taylor on Improving Heart Health For All

New in Clinical Guidance | Newest AUC Provide Clinical Guidance on Cardiac Implantable Electronic Devices

New in Clinical Guidance | ACC Issues Guidance on Arrhythmia Monitoring After Stroke

From the Member Sections | Tackling the Polypharmacy Pandemic in CV Care

Focus on Heart Failure | Thinking Outside the Ice Box: Preservation Techniques, New Technologies in Transplantation

For the FITs | The Emergence of Substance Use Disorders and Their Implications in Cardiovascular Disease

Courageous Conversations | The Invisible Armor: A Personal Reflection on The Power of Resilience as a Black Woman in Cardiology

Quality Improvement For Institutions | NCDR Research: Data Driving Better Practice, Patient Outcomes

Prioritizing Health | Journey of the Health and Well-Being Coaching Profession

Heart of Health Policy | ACC Advocacy Welcomes New Members of Congress

Heart of Health Policy | Action Steps Following CCTA Coding Change From 2025 OPPS Final Rule; Coding Corner: How to Use New ASCVD Risk Assessment and Management Codes

JACC in a Flash | Aircraft Noise Poses Threats to Heart Health; More

The Pulse of ACC | Welcome to Camp Cardiac; ACC.25 Pre-Conference Opportunity: Renal Denervation

Number Check | Powering Quality Improvement

ACC Mission in Action | Making a Global Difference

Heart of Health Policy | Action Steps Following CCTA Coding Change From 2025 OPPS Final Rule; Coding Corner: How to Use New ASCVD Risk Assessment and Management Codes

Heart of Health Policy

Action Steps Following CCTA Coding Change From 2025 OPPS Final Rule

The Centers for Medicare and Medicaid Services (CMS) has temporarily reassigned coronary CT angiography (CCTA) codes 75572-75574 from ambulatory payment classification (APC) 5571 to APC 5572 in the 2025 Outpatient Prospective Payment System (OPPS) final rule. This change will raise reimbursement for these services from a national rate of $175.06 in 2024 to $357.13 in 2025.

Given the temporary status and data dependency of this change, it is imperative that hospital revenue cycle and billing departments are educated on this change and bill the cardiology revenue code when appropriate. Cardiac CT imagers should work with hospital staff and colleagues to understand and implement the following reporting changes:

  • CMS has removed an outdated Return to Provider edit that previously precluded facilities from reporting certain revenue codes.
  • Clinical charge masters can be updated to indicate that revenue codes for cardiac CT tests can be linked to revenue codes 0489x (Cardiology – Other) or 0409x (Other Imaging Services) which have higher cost-to-charge ratios.
  • Additional effort may be needed to change internal software or clearinghouse edits that indicate cardiology or general revenue codes are not allowed, which is now incorrect.

Such a change should not have any impact on how revenue is tracked for different service lines in a hospital. The costs associated with cardiac CT require certain additional cardiac imaging resources that are more than general CT services. This change offers all CT imagers a mechanism to report additional costs.

For several years, the ACC, Society for Cardiovascular Computed Tomography (SCCT) and other stakeholders have been advocating for more appropriate reimbursement for these services to reflect the greater resource intensity required to perform CCTA.

The APC assigned in the OPPS system is based on a cost analysis of a service by CMS. Until December 2023, a coding edit was in place that only allowed hospitals to report costs for CCTA using a CT scan (035x) or diagnostic radiology hospital revenue code (032x) and not a cardiology hospital revenue code (048x). The cardiology revenue code links to higher costs than others, which the societies felt lowered the cost inputs for CCTA and hence artificially held down its cost analysis.

CMS recognized that while the edit was removed, it could take years for the billing practices of hospitals to change and for their cost analysis to more accurately reflect true costs. A simulated cost analysis conducted by CMS found that if 50% of CCTA codes were billed with the cardiology revenue code, the services would qualify to move to the higher APC (5572).

The ACC, SCCT and other stakeholders argued in comments on the proposed rule that as significant education was needed to prompt changes in hospital billing practices, and since CMS uses past data to determine future payment rates, the agency should make the adjustment based on their simulated outcome now and track data moving forward.

CMS was persuaded by these arguments and reassigned the CCTA codes on a temporary basis, using an alternative methodology to determine the assignment. The agency anticipates it would take three to four years for the data to reflect the potential new billing practices given the regulatory change of allowing the cardiology revenue code to be used. If CMS does not see a significant change after "several years," they will revert payment for these services to the standard OPPS payment methodology.

Coding Corner: How to Use New ASCVD Risk Assessment and Management Codes

The Centers for Medicare and Medicaid Services (CMS)  created two new G codes that were included in the 2025 Medicare Physician Fee Schedule final rule. These codes, which provide reimbursement for atherosclerotic cardiovascular disease (ASCVD) risk assessment and risk management services, were inspired by the success of the CMS Innovation Center's Million Hearts Cardiovascular Disease Risk Reduction model, which reduced the rate of death from any cause for medium and high risk patients by 4% and reduced risk of death from a cardiovascular event by 11%.

The ASCVD risk assessment code G0537 is billable for a patient that does not currently have a cardiovascular disease diagnosis or history of heart attack or stroke but does have at least one predisposing condition that may put them at increased risk for future ASCVD diagnosis. Qualifying conditions include, but are not limited to: obesity, family history of cardiovascular disease, high blood pressure, high cholesterol, smoking/alcohol/drug use, prediabetes or diabetes.

There is not a specified tool that must be used for this risk assessment; however, there are specific components that must be present, including:

  • Current (from the last 12 months) laboratory data (lipid panel) for inputs for the risk assessment tool.
  • Administration of a standardized, evidence-based ASCVD risk assessment tool that has been tested and validated through research, and includes the following domains:
    • The output of the tool must include a 10-year estimate of the patient's ASCVD risk. This output must be documented in the patient's medical record.
    • Demographic factors (such as age, sex).
    • Modifiable risk factors for cardiovascular disease (such as blood pressure and cholesterol control, smoking status/history, alcohol and other drug use, physical activity and nutrition, obesity).
    • Possible risk enhancers (such as preeclampsia, prediabetes, family history of cardiovascular disease).
    • Billing practitioners may choose to assess for additional domains beyond those listed above if the tool used requires additional domains.

The ACC ASCVD Risk Estimator is one example of an acceptable tool to use for this risk assessment. Click here to access the tool.

The risk assessment code has been assigned a work relative value unit (RVU) of 0.18 and may be billed once every 12 months per practitioner per patient.

The ASCVD risk management code G0538 is billable when performed on a patient that was found to have intermediate, medium or high risk of cardiovascular disease over the next 10 years per the ASCVD risk assessment.

The risk management services should address the "ABCS" of cardiovascular risk reduction, referring to aspirin (along with statins and other appropriate medications), blood pressure control, cholesterol control and smoking cessation. Specifically, the ASCVD risk management services include:

  • ASCVD Specific Risk Management, which may include:
    • Promoting receipt of preventive services (including tobacco cessation counseling, diabetes screening, diabetes self-management training).
    • Medication management (including aspirin or statins to maintain or decrease risk of cardiovascular disease).
    • Ongoing communication and care coordination via certified electronic health record technology.
    • Synchronous, non–face-to-face communication methods must be offered.
  • ASCVD-Specific, Individualized, Electronic Care Plan:
    • Must address modifiable risk factors and risk enhancers specific to cardiovascular disease, as applicable, such as blood pressure and cholesterol control, smoking/alcohol/drug use status, history and cessation, physical activity and nutrition, and obesity.
    • Plan must be established, implemented, and monitored and must incorporate shared decision-making between the practitioner and patient.

The ASCVD risk management services can be performed by a physician or a qualified health professional who may furnish evaluation and management services under Medicare. CMS emphasizes that patient consent must be obtained for these services. As risk management is not considered a preventive service, cost-sharing may apply. The ASCVD risk management code has been assigned a work RVU of 0.18.

Resources

Clinical Topics: Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Interventions and Imaging, Computed Tomography, Nuclear Imaging

Keywords: Cardiology Magazine, ACC Publications, Centers for Medicare and Medicaid Services, U.S., Computed Tomography Angiography, Costs and Cost Analysis, Fees and Charges