Elucid, an AI medical technology company focused on providing physicians with a more precise view of atherosclerosis to drive patient-specific therapeutic decisions, commends the U.S. Centers for Medicare & Medicaid Services (CMS) for the inclusion of a Category I CPT code for coronary plaque analysis and a national Medicare average payment amount of over $1,000, pending the final Medicare Physician Fee Schedule (PFS) ruling, which will come out in November.
Cardiovascular disease continues to be a critical public health issue in the United States, remaining the leading cause of death nationwide. In 2022, heart disease claimed over 700,000 lives – nearly 1 in every 5 deaths – underscoring the urgent need for early detection and intervention. Despite advances, many high‑risk patients remain undiagnosed until they experience serious cardiac events. The proposed rule by CMS marks a significant step toward broader access to innovative, evidence-based imaging tools that help identify high-risk cardiovascular patients earlier and more accurately.
“Elucid is encouraged by the addition of the Category I CPT code and payment level for coronary CTA with plaque analysis in the Calendar Year 2026 Medicare Physician Fee Schedule proposed rule,” said Elucid CEO Kelly Huang, PhD. “We commend CMS for ensuring that the proposed payment level reflects the clinical value, technological investment, and expertise needed to perform this service, enabling Medicare beneficiaries to access this technology.”
Coronary computed tomography angiography (CTA) with plaque analysis offers invaluable insights into plaque burden, composition, and morphology, enabling earlier and more accurate identification of high-risk patients who may benefit from targeted medical therapy and lifestyle interventions. Numerous studies have demonstrated that such non-invasive imaging enhances risk stratification and clinical decision-making while reducing the need for more invasive and costly diagnostic procedures.
“Elucid remains optimistic as we await the final publication of the code and payment, effective January 1, 2026,” said Huang. “We recognize the efforts of societies and physician organizations collaborating with the AMA and CMS to reach an appropriate payment level. We look forward to continued cooperation to enhance patient outcomes and access.”
The proposed rule outlines payment policies and rates for services furnished under Medicare Part B. The inclusion of coronary CTA with plaque analysis represents a significant advancement for precision cardiovascular care. It follows a new CMS rule that went into effect January 1, 2025, which doubled the amount paid to hospitals and outpatient clinics who perform cardiac CT scans from $175 to $357. This has already allowed more hospitals, particularly those in non-urban areas, to be able to offer this service, reducing disparities in care.
