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 under the 2025 Outpatient Prospective Payment System (OPPS) final rule.
This change increases national reimbursement rates for CCTA from $175.06 in 2024 to $357.13 in 2025.
The reassignment is temporary and dependent on future billing data, emphasizing the need for hospital revenue cycle and billing departments to be educated and adjust their practices accordingly.
Hospitals should update clinical charge masters to ensure CCTA services are linked to cardiology revenue codes like 0489x (Cardiology – Other) or 0409x (Other Imaging Services), which reflect higher cost-to-charge ratios.
Outdated "Return to Provider" edits (#19) that previously prevented facilities from using cardiology revenue codes have been removed.
Hospitals may need to update internal software or clearinghouse edits to allow the use of cardiology-specific revenue codes for CCTA billing.
These updates will not impact how revenue is tracked across hospital service lines but will ensure more accurate reporting of the greater resources required for cardiac CT imaging compared to general CT services.
This change is the result of advocacy by the American College of Cardiology (ACC), the Society for Cardiovascular Computed Tomography (SCCT), and other stakeholders, who argued that prior coding rules suppressed cost inputs for CCTA.
Until December 2023, hospitals could only bill CCTA using general CT scan (035x) or diagnostic radiology (032x) revenue codes, which underreported the costs of these resource-intensive services.
CMS conducted a simulated cost analysis, finding that if 50% of CCTA codes were billed with cardiology revenue codes, the services would qualify for the higher APC (5572).
CMS acknowledged that while the coding edit was removed, it could take years for hospitals to adopt the new billing practices, prompting the agency to adjust payments temporarily using an alternative methodology.
The agency expects it will take three to four years for the data to fully reflect new billing practices. If no significant changes are observed after this period, CMS will revert CCTA payments to the standard OPPS payment methodology.
Take-Home Points:
- CMS temporarily increased reimbursement rates for CCTA to $357.13 in 2025 by reassigning it to a higher APC (5572).
- Hospitals must update billing practices to use cardiology revenue codes (0489x or 0409x) to reflect the true costs of CCTA.
- Outdated coding edits that restricted the use of cardiology revenue codes have been removed, facilitating these updates.
- Accurate billing and education are critical to ensure CMS receives sufficient data to make the reassignment permanent.
- The reassignment follows years of advocacy by stakeholders, who highlighted the resource intensity of CCTA compared to general CT services.
- CMS will monitor data over the next three to four years and may revert payments if hospitals fail to adjust billing practices.
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