New Category I CPT Code for FFR CT Analysis
DEEPVESSEL CT FFR Transitions to a Category I CPT Code 75580DEEPVESSEL FFR (DVFFR) is a coronary physiological simulation software for the clinical quantitative and qualitative analysis of previously acquired Computed Tomography DICOM data for clinically stable symptomatic patients with coronary artery disease. It provides a CT-derived FFR measurement computed from static coronary CTA images using deep learning neural networks that encode imaging, structural, and functional characteristics of coronary arteries through learning. DEEPVESSEL FFR analysis is intended to support the functional evaluation of coronary artery disease.
New Category I CPT Code 75580
Effective January 1, 2024, the AMA has approved a Category I Code, 75580, for billing the FFRCT Analysis, thereby replacing the four existing Category III CPT Codes: 0501T, 0502T, 0503T, and 0504T.
Category I CPT Code 75580 entails the noninvasive estimation of coronary fractional flow reserve (FFR) derived from augmented software analysis of the data set from a coronary computed tomography angiography, with interpretation and reporting by a physician or other qualified healthcare professional.
Reimbursement
| CPT Code | Status Indicator | APC | National Average Medicare Rate |
| 75580 | S | 5724 | $997.22 |
|
CPT Code |
Status Indicator |
Work RVU |
Total Non-Facility and Facility RVUS |
National Non-Facility and Facility Rate |
|
75580 |
A |
0.75 |
27.12 |
$888.02 |
| RVUs = Relative Value Units for the new Category I Code for FFRCT and established consistent national payment for the service. |
| S = Significant procedure not subject to multiple procedure discounting. The national average minimum adjusted co-payment is $199.45. |
| A = Active Code. There will be RVUs and payment amounts for codes with this status. The national average co-payment is 20% of the allowed amount, or $177.57. |
- The Centers for Medicare & Medicaid Services (CMS) have updated their payment policies and rates for the FFRCT service in the Calendar Year (CY) 2024 Hospital Outpatient Prospective Payment System (OPPS) and Physician Fee Schedule (PFS) final rules. Specifically, in the CY 2024 OPPS rule, CMS assigned the new Category I Code for FFRCT to clinical ambulatory payment classification (APC) 5724, Level 4 Diagnostic Tests and Related Services.
- Code 75580 should be used only once per coronary computed tomography angiogram (CCTA).
- If FFRCT is performed on the same day as the CCTA, both 75580 and 75574 should be used together.
- The provider is responsible for determining the appropriate modifier usage. When relevant, modifier 26 should be used for the professional component, and modifier TC for the technical component of the FFRCT service.
We recommend that providers undertake the following actions to ensure patients can access the FFRCT service and that claims are processed efficiently:
- Notify relevant teams about the new Category I Code for FFRCT.
- Implement the code into billing systems by January 1, 2024.
- Update order sets and electronic medical records accordingly.
- Revise the chargemaster to accommodate the FFRCT service.
- Review managed care contracts for payment implications of the new code.
What to include in FFRCT Order
RECOMMENDED: History and Physical (H&P), diagnostic testing, CCTA interpretive report and FFRCT order; Documentation of presenting cardiac symptoms requiring further investigation through FFRCT; CCTA is abnormal or indeterminate; Patient BMI.
