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US Representatives urge CMS to boost CCTA reimbursement

Last month, fourteen members of Congress (seven Democrats and seven Republicans) wrote a joint letter to Centers for Medicare and Medicaid Services Administrator, Chiquita Brooks-LaSure, urging that CMS increase reimbursement for coronary computed tomography angiography (CCTA) under the Hospital Outpatient Prospective Payment System (HOPPS). CCTA is a diagnostic test that produces cross-sectional 3D images of the arteries in the heart to allow radiologists and cardiologists to detect abnormalities in blood flow and to diagnose cardiovascular disease. CCTA also produces clinically important axial images of the chest, lungs and mediastinum.

These members of Congress recommend that CCTA payments can be boosted by reassigning the CPT codes used to bill for CCTA services to ambulatory payment classifications (APCs) that "more appropriately reflect the clinical intensity, resource utilization and cost of these services."

Recently, California Democrat, U.S. Representative Ted W. Lieu had the personal experience where a CCTA  study alerted his care team to the advisability of stent surgery. He and his Congressional colleagues noted to Administrator Brooks-LaSure that the following report language was included in the 2023 Labor-HHS Appropriations Bill: "Cardiac Computed Tomography (CT) - The committee notes that unstable and low reimbursement for cardiac CT services is contributing to significant disparity in access to this vital service among minority populations. Within 90 days of enactment, CMS shall report to the committee on what actions are being taken by the agency to address the inequity."

The representatives stated their hope that this language will further encourage CMS to focus on the adequacy of CCTA reimbursement and to further examine the health disparities among Medicare beneficiaries resulting from lack of access to cardiac CT –  which they called "the preferred and guideline-directed imaging modality for patients with suspected coronary artery disease (CAD)."

They argued that CCTA can help address inequities in cardiac care for communities of color where CAD is 33% higher for Black individuals compared to the overall population and that Native Americans have a nearly 20% higher cardiovascular mortality rate compared to white individuals.

While this letter focuses on the non-physician components of CCTA studies, it would be prudent to also assure the adequacy of the professional component for these studies as well. My experience is that only one physician (either cardiologist or radiologist) can bill for the CCTA interpretation. But it is often necessary, however, for them to share the performance of the interpretation of these studies..

Along with Lieu, signatories include Mark Amodei (R-NV), Jake Auchincloss (D-MA), Sanford Bishop (D-GA), Larry Bucshon, MD (R-IN), Tom Cole (R-OK), Andy Harris (R-MD), Mike Kelly (R-PA), Jimmy Panetta (D-CA), Terri Sewell (D-AL), Kim Schrier, MD (D-WA), Adrian Smith (R-NE), Mike Thompson (D-CA) and Joe Wilson (R-SC).

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health care & life sciences, diagnostic radiology

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