We included 15,710 cases of 64-slice CCTA from 26 practices/hospitals across the U.S. pre-electrophysiology anatomic mapping andĬoronary calcium scoring, while potentially yielding clinically relevant data, remains a screening test and is consequently considered a "retail service," with the patient paying directly for this procedure.in postrevascularization patients having CAD symptoms.following an equivocal nuclear perfusion study.While the clinical appropriateness criteria vary among carriers and policies, most accept the following as appropriate indications for CCTA: Most policies stipulate that the scanning equipment suitable to perform coronary CTA must be 64 slices or the equivalent thereof. However, it is critical to verify the elements of any specific policy with local carriers. While current coverage policies vary by carrier and by region, the majority contain many similar components. Payers must safeguard against this by allowing reimbursement only to those sites complying with the established competency statements and standards. The American College of Cardiology, American College of Radiology, Society of Cardiovascular Computed Tomography, and others have developed appropriateness criteria for CCTA that establish guidelines for proper use of this technology.Īnother avenue to overutilization and potential inappropriate utilization is reimbursement without regulation. The underlying concern that CCTA could evolve into a screening tool is legitimate, but patient screening is not the intent or scope of CCTA. Using CCTA for the sole purpose of screening patients absent symptoms and without risk or at low risk for coronary artery disease can also lead to overutilization. In an era of severe scrutiny regarding diagnostic testing, the layered test will not be tolerated. The prospect of the practitioner ordering a nuclear perfusion study followed by a CCTA and then followed by a diagnostic catheterization alarms payers. If CCTA becomes simply an additional "layered" diagnostic test, the system has realized no benefit or savings. broad use of CCTA as a screening test and.Three primary trends have the potential to encourage over-, and perhaps inappropriate, utilization trends: The key concerns of payers are centered on overutilization of CCTA. Substitutions for catheter angiography are particularly appealing to the payer, as the global reimbursement for diagnostic catheterization is approximately 300% that of CCTA. Consequently, a savings is inherent whenever CCTA is substituted for either of these more costly diagnostic procedures. CCTA is reimbursed, where applicable, well below the global reimbursement rates for both nuclear perfusion testing and diagnostic catheter angiography. The key benefit to payers is potential cost savings, but they are concerned that CCTA may increase imaging study volumes, thereby costing the system money.įor the payer and the healthcare system to realize a savings from CCTA, the procedure must replace, not accompany, other diagnostic imaging modalities. The benefits of CCTA are plentiful to the practitioner and the patient, yet they appear less obvious to some payers. Preliminary results indicate that coronary CTA is being utilized appropriately and affects savings for the healthcare system. To address these concerns, we have developed the CCTA Data Registry, which now consists of more than 20,000 cases. Questions remain from practitioners, payers, and administrators regarding the economic impact of coronary CT angiography on established diagnostic modalities and the effects on reimbursement within imaging.
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