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- CMS has removed an outdated Return to Provider edit (#19) that previously precluded facilities from reporting certain revenue codes.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. That is 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.
Clinical Topics: Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Interventions and Imaging, Computed Tomography, Nuclear Imaging
Keywords: Computed Tomography Angiography, Centers for Medicare and Medicaid Services, U.S., Personnel, Hospital, Costs and Cost Analysis