New reimbursement recommendations support earlier, non-invasive identification of high-risk cardiovascular patients

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.

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 PlaqueIQTM 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 FFRCT, derived from its plaque algorithm, to help identify coronary blockages and the extent of ischemia non-invasively. For more information, visit elucid.com.

1 Centers for Disease Control and Prevention. Heart Disease Facts. Last reviewed January 24, 2024. Available at: https://www.cdc.gov/heart-disease/about/index.html

Media Contact:
Sam Choinski
Pazanga Health Communications
(860) 301-5058
schoinski@pazangahealth.com

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