Identify CCTA Code With AI Analysis in 2026 MPFS Proposed Rule
Question: Will the 2026 Medicare Physician Fee Schedule (MPFS) include reimbursement for artificial intelligence (AI) software? RCI Subscriber Answer: The 2026 MPFS proposed rule did include a CPT® code and proposed payment for an AI solution. On July 16, 2025, the Centers for Medicare & Medicaid Services (CMS) published the MPFS proposed rule for calendar year (CY) 2026 to the Federal Register. In the proposed rule, the agency notes that the CPT® Editorial Panel created a new Category I CPT® code in September 2024: The Editorial Panel also deleted four Category III CPT® codes tied to coronary atherosclerotic plaque assessment. CMS is recommending reimbursement for coronary plaque assessment software, which is powered by AI. You’ll notice that the code descriptor includes the phrase, “derived from augmentative software analysis.” Cleerly, Elucid, and HeartFlow are vendors that provide the analysis software, and AI in the products evaluates coronary CT angiography (CCTA) images for signs of heart disease. CMS also recognizes plaque characterization analysis software as a supply item that contributes to the direct practice expense (PE) inputs. This software carries a $1,500 per-patient fee for an analysis summary from the vendor. Kelly Huang, PhD, CEO of Elucid, stated that the company applauds CMS for including CCTA with plaque analysis in the proposed rule as well as taking care to ensure the suggested reimbursement level reflects the investment, value, and knowledge needed to perform the service. “Elucid remains optimistic as we await the final publication of the code and payment, effective Jan. 1, 2026,” Huang said in a press release. “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.” Mike Shaughnessy, BA, CPC, Development Editor, AAPC
