Oct. 15, 2024 — Four of the seven Medicare Administrative Contractors (MACs) have released final local coverage determinations (LCD) for AI-Coronary Plaque Analysis (AI-CPA).
The four contractors for the U.S. Centers for Medicare and Medicaid Services (CMS) – including CGS, National Government Services (NGS), Palmetto GBA and Wisconsin Physicians Service Insurance Corporation (WPS) – provided updated LCDs for current procedural terminology (CPT) codes 0623T - 0626T.
Per the new LCDs, AI-CPA using coronary computed tomography angiography (CCTA) is considered reasonable and medically necessary as a diagnostic study when the patient is eligible for CCTA; and the patient presents with acute or stable chest pain and is at intermediate risk for coronary artery disease (CAD) or has evidence of CAD-RADS™ level 1, 2 or 3 disease on their CCTA; and the patient is negative or inconclusive for acute coronary syndrome (ACS).
The LCDs have a future effective date of Nov. 24, 2024.
Members of the Society of Cardiovascular Computed Tomography (SCCT) Health Policy & Practice Committee (HPPC) presented as subject matter experts during a May 2023 MAC-led Multijurisdictional Meeting on CAC Non-Invasive Technology for Coronary Artery Plaque Analysis and later provided comments on the draft LCDs that helped shape the final policies.
“This is a positive step towards improved patient care,” said Ahmad Slim, MD, FSCCT, director of imaging at Pulse Heart Institute and chair of the HPPC. “Increased access to AI-CPA, AI-augmented plaque assessment analysis tools, will help medical teams make more informed decisions for their patients, and have the potential to reduce unnecessary invasive procedures downstream."
In regard to the remaining MACs, Noridian has not published their final LCD, although it is expected within a few days. Novitas Solutions and First Coast Service Options, Inc. (FCSO) continue to consider coverage for AI-CPA on a case-by-case basis.
The SCCT HPPC offers tools for administrators to navigate the complex landscape of insurance plans, billing and reimbursement on SCCT website, scct.org.
December 19, 2024 
