Introduction
The Centers for Medicare & Medicaid Services (CMS) has proposed a 57% reimbursement cut for pyrophosphate (PYP) scintigraphy, a cornerstone imaging test for diagnosing transthyretin amyloid cardiomyopathy (ATTR-CM). This reduction, buried in the 2026 Hospital Outpatient Prospective Payment System (HOPPS) proposed rule, has triggered urgent protests from the American Society of Nuclear Cardiology (ASNC) and nuclear cardiologists nationwide. With the comment period closing September 15, the stakes are high: patient access, equity in care, and the very momentum of amyloidosis recognition and treatment may be jeopardized.
Why PYP Imaging Matters
PYP/amyloid imaging transformed amyloidosis from a rare diagnostic curiosity to a mainstream, noninvasive test. It allows cardiologists to confirm ATTR-CM without biopsy in nearly 85% of cases. This has fueled:
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Early detection of a disease more common than previously thought
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Recruitment into clinical trials of novel therapies
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Patient access to FDA-approved drugs such as tafamidis (Vyndamax/Vyndaqel, Pfizer), vutrisiran (Amvuttra, Alnylam), and acoramidis (Attruby, BridgeBio)
Importantly, PYP imaging does not require high-cost infrastructure; any center with a SPECT camera used for coronary artery disease stress testing can perform it—provided trained nuclear imagers are available.
The Proposed Cut and Its Impact
CMS plans to reassign CPT code 78803—currently reimbursed at $1,305.48—to a lower ambulatory payment classification (APC), slashing reimbursement to $558.70. The rationale ties to a policy requiring separate payments for isotopes exceeding $630.
This broad reclassification ignores the relatively low isotope cost for PYP scans, yet still imposes the same drastic cut. Consequences include:
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Reduced institutional interest in offering the test
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Widening healthcare disparities, especially among underserved African American populations disproportionately affected by hereditary ATTR-CM
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Diminished clinical adoption at a time when amyloidosis programs are expanding nationwide
Expert Voices: A Growing Field at Risk
Leaders in nuclear cardiology warn that the cuts would be “devastating” for the field. Just a decade ago, ATTR-CM lacked effective treatments; today, the combination of PYP imaging and life-prolonging therapies has redefined patient care.
If implemented, the CMS proposal could:
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Stall further recognition of amyloidosis prevalence
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Threaten the nascent pipeline of amyloid programs in U.S. hospitals
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Undermine equitable access to diagnosis for at-risk populations
Policy Solutions on the Table
ASNC urges CMS to:
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Delay reclassification of CPT 78803 until more data are available.
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Consider a new dedicated CPT code for PYP imaging, separating it from unrelated and costlier nuclear medicine procedures.
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Allow time for geometric mean cost data collection over several years before implementing cuts.
Key Takeaways
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PYP imaging is central to diagnosing ATTR-CM and enabling access to new therapies.
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The proposed 57% CMS cut would drastically reduce reimbursement, potentially stalling a field that has only recently gained momentum.
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Healthcare disparities could worsen, especially for underserved populations at higher risk.
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ASNC and nuclear cardiologists are calling for urgent action before the September 15 comment deadline, advocating for either delaying the cuts or establishing a dedicated CPT code to protect patient access and innovation.
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