The American College of Radiology (ACR) is sounding the alarm for hospital-based imaging providers: a recent, massive pay increase for Coronary CT Angiography (CCTA) is at risk of being revoked unless facilities change how they bill for these services.
Why it matters: In its 2025 final rule, CMS temporarily moved CCTA (CPT 75572–75574) from a Level 1 to a Level 2 Ambulatory Payment Classification (APC).
- The windfall: Technical fees jumped 104%, rising from $175 in 2024 to $357 currently.
- The catch: CMS made this change “provisionally.” If fewer than 50% of hospitals update their billing to reflect the true resource intensity of CCTA, Medicare will revert to the lower, generic CT payment rates.
| CY 2024APC 5571 | CY 2025APC 5572 | % Change | |
|---|---|---|---|
| Hospital Outpatient (OPPS) | $175 | $357 | +104% |
| Physician Office (PFS) | $285 | $318 | +12% |
The Friction: Historically, hospitals were forced to use a generic “CT Scan” revenue code (0350), which has a lower cost-to-charge ratio. CMS has now removed the “Return to Provider” edits that blocked hospitals from using more accurate codes.
Action Items: To make the pay hike permanent, the ACR, ACC, and SCCT recommend:
- Update Charge Masters: Map CCTA CPT codes to Cardiology (0480/048x) or Other Imaging Services (040x) revenue codes.
- Reflect Intensity: Reporting costs under these specific codes demonstrates the specialized nursing and resource needs that justify the higher APC level.
- Monitor Denials: Ensure clearinghouses and private payers accept the updated cardiology revenue codes.
The Bottom Line: If facilities continue to report CCTA expenses as identical to generic CT scans, the data will fail to support the higher payment level, and the $182-per-scan “bonus” will vanish.
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