Medicare payment for cardiac CT has declined since Category I code adoption, according to research published September 30 in the Journal of Cardiovascular Computed Tomography.
Inflation-adjusted Medicare payment for cardiac CT decreased by 27% to 68% between 2010 and 2026, and this decline hastened during the period of strongest guideline endorsement, wrote a team led by Muhammad Naeem MBBS, MD, from Mayo Clinic Arizona in Phoenix.
“Valuation policy for cardiac CT has moved opposite to its evidence base, and the two components of that movement warrant distinct policy responses,” the Naeem team wrote.
Coronary CT angiography (CCTA) received a Class 1 recommendation in 2021 AHA/ACC chest pain guidelines by the American Heart Association (AHA) and the American College of Cardiology (ACC). The researchers noted that where Medicare payment is heading for cardiac CT over the Category I era has not been quantified.
As a result, Naeem and colleagues studied nominal and inflation-adjusted Medicare Physician Fee Schedule (PFS) payment for cardiac CT across the complete Category I era, 2010 through 2026. They calculated national unadjusted non-facility payment for global, professional, and technical components as total relative value units (RVUs) multiplied by the conversion factor.
Inflation-adjusted global payment declined for all four core codes between 2010 and 2026: −68.3% for CCTA (75574), −53.6% for congenital cardiac CT (75573), −50.2% for structural cardiac CT (75572), and −27.4% for coronary calcium scoring (75571).
The technical component faced the steepest declines (−74.8% for 75574; RVU reductions up to 58.7%). Professional payment meanwhile fell from 35.9% to 37.5% with work RVUs unchanged until the 2.5% efficiency adjustment of 2026. This translates to a 38.8% real decline in the conversion factor, the researchers noted.
Among other findings, the researchers reported the following:
· Chest CT angiography fell 57.9%, with a professional decline close to the cardiac codes (−40.7%) but a smaller technical decline (−62.5% vs. −74.8%).
· The largest single-year reduction occurred in 2011 (−36.4% for 75574).
· In the five years after the 2021 guideline, real global payment fell a further 24.2% to 34.2%.
· Between 2013 and 2024, CCTA volume rose 408% while the average real allowed charge per service fell 45.9%. This decline “partly” reflects migration of billing to facility settings, the researchers wrote.
“Real allowed fee schedule spending rose $22.0 million, comprising a $51.4 million volume effect offset by unit revenue [−$5.8 million] and interaction [−$23.6 million] effects; hospital technical payment is not captured,” the team added.
Read the full study, along with avenues that the authors outlined to address this issue, here.