The Centers for Medicare and Medicaid Services (CMS) summarized a recent billing edit change in the 2025 Hospital Outpatient Prospective Payment System (OPPS) proposed rule, which fixes an issue that previously prevented hospitals from reporting costs for cardiac computed tomography (CT) as cardiology services. Since OPPS payment is based on reported costs, reporting costs as cardiology instead of radiology could affect the way costs are attributed to specific services and impact payment rates.  

CMS ran a simulation, where 50% of services were reported as cardiology costs and 50% as radiology costs, which demonstrated increased costs that would warrant an increase in payment for cardiac CT services reported by codes 75572, 75573 and 75574. CMS did not propose a change to payment rates in the 2025 proposed rule as the possibility to report costs in this manner has only been available since December 2023; however, the agency posed several questions for public feedback:  

1. Where are cardiac CT services performed in a hospital? Are cardiac CT services performed in a dedicated cardiology department, radiology department or another hospital outpatient department? 
2. What factors determine the revenue code assignment for cardiac CT services (i.e., the department in which the service is performed, the type of service that is performed or another factor)? 
3. What revenue codes are hospital outpatient departments (HOPDs) reporting for these services in calendar year 2024? Are HOPDs using the cardiology revenue code on claims for cardiac CT services now that they are no longer restricted from using this revenue code? 

The ACC, in concert with the Society of Cardiovascular Computed Tomography, has raised concerns about the additional costs of cardiac CT over thoracic CT for years. The billing change and subsequent questions from CMS present an opportunity to inform future changes to cardiac CT payment. The College will submit formal comments in response to these questions and urge CMS to make a change in payment in the final rule based on their modeling. CMS will issue the final rule around Nov. 1.  

ACC members who provide these services can also reply to these questions. A letter template is available for members to personalize and send to CMS as an ACC Action Alert.

Keywords: ACC Advocacy, Centers for Medicare and Medicaid Services, U.S., Tomography Scanners, X-Ray Computed, Feedback

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