Centers for Medicare and Medicaid Services finalise a new technology ambulatory payment classification for HeartFlow

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HeartFlow FFRct

HeartFlow has announced that the Centers for Medicare & Medicaid Services (CMS) has finalised a new technology ambulatory payment classification (APC) for the HeartFlow FFRct analysis—a first-of-its-kind non-invasive technology that helps clinicians diagnose and treat patients with suspected coronary artery disease.

Under the APC payment system, hospitals enrolled in Medicare that bill CMS for the HeartFlow FFRct analysis for Medicare patients will be eligible for reimbursement at a rate of US$1,450.50 for the technical component of the test. This payment rate will take effect on January 1, 2018.

John H Stevens, president and chief executive officer of HeartFlow, comments: “The CMS decision to assign a new technology APC for the HeartFlow FFRct analysis is a major milestone and will ensure that our innovative, non-invasive technology can be used for Medicare beneficiaries. This is a significant development, given the high prevalence of coronary artery disease in people over age 65. This decision is a testament to the wealth of clinical evidence and cost data that support the use of the HeartFlow FFRct analysis as a critical, potentially life-saving technology.”

HeartFlow FFRct analysis, a press release reports, provides insight into both the extent of coronary artery disease and the impact of the disease on blood flow to the heart. It uses high-quality images from a coronary computed tomography (CT) angiogram to provide clinicians with functional information in order to offer actionable information on the optimal course of treatment.

“CMS’s decision to assign a new technology APC for FFRct technology for Medicare recipients is a recognition of the value of this technology and its demonstrated ability to reduce the number of invasive diagnostic coronary angiography procedures and help medical centers reduce costs. The HeartFlow Analysis is an important tool in helping us assess patients with suspected coronary artery disease and better understand how their coronary blockages affect blood flow to the heart,” says Pamela Douglas (Ursula Geller Professor for Research in Cardiovascular Disease in the School of Medicine at Duke University, USA).

Previously, the American Medical Association (AMA) issued a set of Category III Current Procedural Terminology (CPT) codes for the HeartFlow FFRct analysis. These codes, according to the press release, provide evidence that the system is a unique and distinct procedure that provides important and actionable clinical information above and beyond that of a coronary CT angiogram. Beginning on January 1, 2018, hospitals using the HeartFlow FFRct analysis will be able to generate claims when it is ordered for patients with suspected coronary artery disease via the use of specific CPT codes.

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