Noninvasive test for CAD to be reimbursed by CMS in 2018

A noninvasive technology that allows clinicians to view a simulated, three-dimensional model of a patient’s coronary blood flow will be reimbursed by CMS beginning in 2018, HeartFlow announced Nov. 6.

The technology, called HeartFlow FFRct Analysis, can be used to diagnose coronary artery disease (CAD) and determine courses of treatment without the need for invasive heart catheterizations. Under a New Technology Ambulatory Payment Classification (APC), hospitals that bill CMS will be eligible to receive a $1,450.50 reimbursement for performing the technical component of the test on Medicare patients.

“CMS’s decision to assign a New Technology APC for FFRct technology for Medicare recipients is a recognition of the value of this technology and its demonstrated ability to reduce the number of invasive diagnostic coronary angiography procedures and help medical centers reduce costs,” Pamela Douglas, MD, Ursula Geller Professor for Research in Cardiovascular Disease at Duke University and past president of the American College of Cardiology, said in a press release. “The HeartFlow Analysis is an important tool in helping us assess patients with suspected coronary artery disease and better understand how their coronary blockages affect blood flow to the heart.”

The HeartFlow FFRct Analysis takes high-quality images from a noninvasive coronary CT angiogram and then uses deep learning to create a 3D model of a patient’s coronary arteries. A one-year study of the technology found mean costs were 33 percent lower with FFRct than the standard of care.

It is estimated that 16.8 million Americans have CAD, which reduces the blood flow to heart and can cause chest pain, heart attack and death. More than 65 million Americans are enrolled in Medicare, according to CMS.

“The decision by CMS will help in the diagnosis and treatment of patients with suspected CAD and means the number of patients over age 65 who will have access to this technology will significantly increase,” said Daniel Simon, MD, president of University Hospitals Cleveland Medical Center. “At our center, the use of the HeartFlow FFRct Analysis is transforming how we diagnose and treat patients with coronary artery disease, helping us move closer to achieving the triple aim of improving the patient experience, improving the health of our patients, and reducing healthcare costs at our institution.”

In August, HeartFlow announced its technology had been made available to more than 44 million patients covered by Anthem Blue Cross Blue Shield, Blue Shield of California and Blue Cross and Blue Shield of Alabama. Aetna has also issued a positive coverage decision for the system.