Latest news with #MedicarePhysicianFeeSchedule
Business Wire
2 days ago
- Health
- Business Wire
Elucid Applauds CMS Inclusion of Coronary CTA with Plaque Analysis in 2026 Proposed Medicare Physician Fee Schedule
BOSTON--(BUSINESS WIRE)-- Elucid, an AI medical technology company focused on providing physicians with a more precise view of atherosclerosis to drive patient-specific therapeutic decisions, today released a statement commending U.S. Centers for Medicare & Medicaid Services (CMS) for the inclusion of a Category I CPT code for coronary plaque analysis and a national Medicare average payment amount of over $1,000, pending the final Medicare Physician Fee Schedule (PFS) ruling, which will come out in November. 'Elucid is encouraged by the addition of the Category I CPT code and payment level for coronary CTA with plaque analysis in the Calendar Year 2026 Medicare Physician Fee Schedule proposed rule,' said Elucid CEO Kelly Huang, PhD. Cardiovascular disease continues to be a critical public health issue in the United States, remaining the leading cause of death nationwide. In 2022, heart disease claimed over 700,000 lives—nearly 1 in every 5 deaths—underscoring the urgent need for early detection and intervention. 1 Despite advances, many high‑risk patients remain undiagnosed until they experience serious cardiac events. The proposed rule by CMS marks a significant step toward broader access to innovative, evidence-based imaging tools that help identify high-risk cardiovascular patients earlier and more accurately. 'Elucid is encouraged by the addition of the Category I CPT code and payment level for coronary CTA with plaque analysis in the Calendar Year 2026 Medicare Physician Fee Schedule proposed rule,' said Elucid CEO Kelly Huang, PhD. 'We commend CMS for ensuring that the proposed payment level reflects the clinical value, technological investment, and expertise needed to perform this service, enabling Medicare beneficiaries to access this technology.' Coronary computed tomography angiography (CTA) with plaque analysis offers invaluable insights into plaque burden, composition, and morphology, enabling earlier and more accurate identification of high-risk patients who may benefit from targeted medical therapy and lifestyle interventions. Numerous studies have demonstrated that such non-invasive imaging enhances risk stratification and clinical decision-making while reducing the need for more invasive and costly diagnostic procedures. 'Elucid remains optimistic as we await the final publication of the code and payment, effective January 1, 2026,' said Huang. 'We recognize the efforts of societies and physician organizations collaborating with the AMA and CMS to reach an appropriate payment level. We look forward to continued cooperation to enhance patient outcomes and access.' The proposed rule outlines payment policies and rates for services furnished under Medicare Part B. The inclusion of coronary CTA with plaque analysis represents a significant advancement for precision cardiovascular care. It follows a new CMS rule that went into effect January 1, 2025, which doubled the amount paid to hospitals and outpatient clinics who perform cardiac CT scans from $175 to $357. This has already allowed more hospitals, particularly those in non-urban areas, to be able to offer this service, reducing disparities in care. About Elucid Elucid is a Boston-based AI medical technology company dedicated to developing technology designed to provide physicians with a more precise view of atherosclerosis (coronary plaque buildup), the root cause of cardiovascular disease. The company's PlaqueIQ TM image analysis software is designed to help physicians prioritize and personalize treatment based on actual disease, rather than population-based risk of disease. PlaqueIQ includes the only FDA-cleared computed tomography angiography (CTA) algorithm that objectively quantifies plaque morphology validated against ground truth histology, the gold standard for characterization of plaque, as indicated by renowned pathologists. PlaqueIQ equips physicians with critical information regarding the type and amount of plaque in arteries that can lead to heart attack and stroke. Elucid is also pursuing an indication for FFR CT, derived from its plaque algorithm, to help identify coronary blockages and the extent of ischemia non-invasively. For more information, visit
Malaysian Reserve
2 days ago
- Business
- Malaysian Reserve
2026 Medicare Physician Fee Schedule Rates Set for Scalp Cooling CPT Codes
SAN DIEGO, July 15, 2025 /PRNewswire/ — Cooler Heads, a health tech company dedicated to making scalp cooling more accessible and affordable for people undergoing chemotherapy, celebrates a major milestone in the effort to expand access to their hair-preserving treatment. The Centers for Medicare & Medicaid Services (CMS) has released its 2026 Medicare Physician Fee Schedule (MPFS) Proposed Rule, which includes three new Category I CPT® codes for mechanical scalp cooling, each assigned a proposed payment rate. This is the first time scalp cooling has been included in the Medicare Physician Fee Schedule, marking a critical step forward in establishing consistent reimbursement. 'This decision is important for patients suffering from hair loss, a devastating and visible side effect of chemotherapy,' said Kate Dilligan, Founder and CEO of Cooler Heads. 'These new codes and proposed rates are a positive step towards helping all patients undergoing treatment for solid tumor cancers preserve their identity during treatment.' CMS has proposed payment rates for three new CPT® codes related to mechanical scalp cooling. The first code, covering the initial fitting of the scalp cooling cap and patient education, would be reimbursed at $1,701. The second code, for the pre-infusion cooling period, is proposed at $10 per treatment. The third code, covering the post-infusion cooling period in 30-minute increments, would be reimbursed at $6 per unit. The new codes do not apply to manual cold caps, highlighting the importance of FDA-cleared mechanical scalp cooling systems like Amma™. This decision also sets a precedent for private insurers to develop their own coverage policies, increasing the likelihood of broader access to patients. After the public comment period concludes on September 12, 2025, and any subsequent updates are made, CMS is expected to release the Final Rule in November 2025. The revised Medicare Physician Fee Schedule (MPFS) rates and updated CPT codes will take effect on January 1, 2026. This timeline presents an exciting opportunity for Cooler Heads to collaborate with health systems. Contact:press@ About Cooler Heads: Cooler Heads, based in San Diego, provides evidence-based products, content, and services that cancer patients need to manage the challenging side effects of treatment. Founded by a cancer survivor, Cooler Heads is driven by the mission to reduce the physical and emotional toll of cancer treatment, offering tools like Amma to improve the quality of life for patients.
