The rapid rise of artificial intelligence (AI) has helped cardiologists, radiologists, nurses and other healthcare providers embrace precision medicine in a way that ensures more heart patients are receiving personalized care. Five of seven Medicare Administrative Contractors have now approved payment for a CT imaging artificial intelligence software.
The coverage determination pertains to AI-enabled, CT-based heart disease assessment. Providers have the potential to earn Medicare payment if the software is deployed in medically appropriate scenarios. These include when an individual is eligible for coronary CT angiography, presents with acute chest pain, and has no known heart disease.
Vendors offering the AI software include Cleerly, HeartFlow and Elucid.
“Coronary artery disease is the underlying cause of about 50% of deaths,” Ron Blankstein, MD, director of cardiac CT at Brigham and Women’s Hospital in Boston, said in an Oct. 24 announcement from HeartFlow. “The earlier we can diagnose and use tools to provide accurate plaque quantification, the earlier we can provide tailored treatments, potentially improving outcomes for patients,” he added later.
Coverage of the AI software will begin Nov. 24 for Medicare Administrative Contractors including WPS, CGS, Palmetto and NGS. The fifth MAC, Noridian, will start Dec. 8.
Reimbursement extends to Medicare beneficiaries with acute or stable chest pain and less than 70% stenosis found on coronary CT angiography (CCTA). The Centers for Medicare and Medicaid Services previously established a national payment amount of $950 when using this AI software in hospitals. The two MACs still refusing to reimburse for coronary CT AI will review payment requests on a case-by-case basis, California-based HeartFlow noted.
Cleerly also praised the CMS payment approval in a statement shared with Radiology Business sister site Cardiovascular Business .
“This decision means that 60.6 million Medicare beneficiaries and 33 million Medicare Advantage beneficiaries—an incredible 93.6 million total individuals—will now have access to noninvasive CT imaging,” James K. Min, MD, founder and CEO of Denver-based Cleerly, said in a statement. “This advancement is a monumental step forward in our mission to eliminate heart attacks and establish a new standard of care for heart disease.”
The American College of Radiology gave further details about the AI software […]
5 of 7 Medicare Administrative Contractors approve payment for imaging AI software