HeartFlow earns reimbursement win for AI-based coronary solutions

HeartFlow announced today that the American Medical Association (AMA) transitioned reimbursement codes for its coronary artery disease assessment.

The AMA changed the non-invasive, AI-based FFR_CT treatment to a Category I Current Procedural Terminology (CPT) code. It went into effect on Jan. 1, 2024. Mountain View, California-based HeartFlow says the new code supports FFR_CT as the standard of care in assessing patients with suspected CAD.

FFR_CT Analysis and coronary computed tomography angiography (CCTA), provide an alternative to traditional ischemia testing methods. These methods include stress EKG, stress ECG, SPECT, PET and more. According to HeartFlow, these methods can result in false negatives 20%-30% of the time.

HeartFlow’s method non-invasively diagnoses CAD and offers guidance on subsequent treatment decisions. The AI-powered technology provides insights into each patient’s condition with a patient-specific model of the heart’s blood flow. It serves customers reliably with a median turnaround time registering less than 1.5 hours.

In the hospital setting, CMS increased payment for the service by around 7% for 2024. Hospital outpatient settings, physician offices or imaging centers can use the new code.

AMA also released guidance for how to appropriately use the new code. Physicians can examine and query the entire model and capture non-invasive estimated coronary FFR values anywhere within the coronary tree. They can also examine multiple and sequential lesions. Additionally, physicians may determine the location of the disease burden and lesion with the most hemodynamic significance allowing for a targeted interventional approach.

“We appreciate the American Medical Association’s decision to assign FFR_CT a Category I CPT code, a decision backed by years of research that highlights the positive impact FFR_CT can have on the diagnosis and eventually treatment of patients with coronary artery disease,” said John Farquhar, CEO of HeartFlow. “This recognition emphasizes the value and importance of FFR_CT Analysis to help clinicians accurately diagnose CAD in patients. Better reimbursement for hospitals leads to improved accessibility to this technology, which is a win for everyone involved, most notably patients.”