In a significant step forward for artificial intelligence (AI) in healthcare, the American Medical Association (AMA) has announced a new Category I Current Procedural Terminology (CPT) code for AI platforms that quantify coronary plaque and identify coronary artery disease (CAD) from imaging results. This new code, which will officially take effect in January 2026, applies to AI technologies from several companies, including HeartFlow, Cleerly, and Elucid. These platforms analyze coronary CT angiography (CTA) images and help clinicians identify high-risk signs of CAD, enhancing the ability to personalize patient care.
Transition from Category III to Category I CPT Codes
Previously, some AI-enabled coronary plaque quantification platforms were classified under temporary Category III CPT codes, used for emerging technologies that require further data collection. However, Category I CPT codes are reserved for established procedures and technologies, signifying broader acceptance and recognition of their clinical value. This shift to a permanent code underscores the growing role of AI in diagnosing and managing cardiovascular conditions.
As of now, the new CPT code for these AI technologies is identified as 75XX6, though the final code will be confirmed closer to its implementation date.
AMA’s Decision and Broader Impact
The AMA’s decision to create a Category I CPT code was made during one of its monthly panels, signaling the growing importance of AI in healthcare diagnostics. A full summary of the panel, which includes other significant updates in healthcare coding, is available through the AMA’s official channels.
This announcement is particularly notable as it coincides with recent developments at the Centers for Medicare and Medicaid Services (CMS). In October 2023, CMS finalized a new local coverage determination (LCD) expanding Medicare coverage for AI-driven coronary plaque analysis platforms. The decision, supported by four out of seven Medicare Administrative Contractors (MACs), goes into effect on November 24, 2023, making it easier for Medicare beneficiaries to access these advanced diagnostic tools.
Industry Reactions: A Game-Changer for Cardiovascular Diagnostics
The announcement of both the new AMA CPT code and expanded Medicare coverage has been met with enthusiasm from the companies leading the charge in AI-powered coronary plaque analysis.
HeartFlow
HeartFlow, a California-based company, has been at the forefront of AI-driven cardiovascular diagnostics. Following CMS’s expanded Medicare coverage, the company issued a statement praising the decision. John Farquhar, CEO of HeartFlow, emphasized the significance of these developments:
“We commend the MACs for recognizing the value and critical role of AI-enabled plaque quantification technologies in cardiovascular disease management,” Farquhar said. “Medicare’s coverage of HeartFlow Plaque Analysis is a significant step forward for cardiovascular disease diagnosis and treatment, expanding access for patients who will see great benefit from more targeted and effective interventions.”
HeartFlow also welcomed the AMA’s decision to issue a new Category I CPT code. Dr. Campbell Rogers, HeartFlow’s chief medical officer, noted the clinical impact of the company’s Plaque Analysis technology:
“It has been shown that with HeartFlow’s Plaque Analysis, two out of three patients had their medical management changed and more precisely tailored, which could contribute to better treatment decisions and improved outcomes.”
Cleerly
Cleerly, another key player in the AI-driven plaque analysis space, also celebrated the AMA’s decision. James K. Min, MD, founder and CEO of Cleerly, acknowledged the long process of gaining approval for the new CPT code:
“Our team at Cleerly initiated this process with AMA more than five years ago, and we could not be more thankful to the many societies and physicians that have supported us in the process,” Min said. “AMA takes great care in considering the codes it issues and we are so appreciative for the recognition of the strength of the Cleerly clinical evidence and utilization data that have proved its value.”
Cleerly’s platform focuses on providing clinicians with detailed, AI-driven insights into coronary artery disease, helping guide more personalized treatment decisions.
Elucid
Elucid, a Boston-based company specializing in AI-powered cardiovascular imaging, expressed cautious optimism about the new CPT code. Kelly Huang, PhD, CEO of Elucid, shared the company’s excitement:
“We remain cautiously optimistic as we await final publication of the code, effective Jan. 1, 2026,” Huang said. “We recognize the efforts of the societies and physician organizations working alongside the AMA and look forward to continued collaboration to support efforts toward improving patient outcomes.”
A New Era in Cardiovascular Care
The combined impact of the AMA’s new CPT code and CMS’s expanded Medicare coverage marks a new era for cardiovascular care. With these AI-enabled technologies, clinicians can more accurately assess coronary plaque and manage CAD, leading to improved patient outcomes and potentially life-saving interventions.
AI-driven solutions like HeartFlow, Cleerly, and Elucid are not only transforming diagnostics but are also providing data that can significantly alter the course of treatment. According to a report by MarketsandMarkets, the global AI in healthcare market is expected to grow from $14.6 billion in 2023 to $102.7 billion by 2030, driven by innovations like these in diagnostics and disease management. This rapid growth highlights the increasing importance of AI in enhancing healthcare services and outcomes.
As healthcare continues to adopt AI-driven technologies, the potential to improve diagnostics, treatment, and patient outcomes is immense. With the support of new CPT codes and expanded insurance coverage, these innovations will likely become a standard part of cardiovascular care in the years to come.
The AMA’s introduction of a Category I CPT code for AI-based coronary plaque analysis, coupled with CMS’s expanded Medicare coverage, represents a significant advancement in the use of AI for cardiovascular diagnostics. As technologies like HeartFlow, Cleerly, and Elucid continue to evolve, they offer healthcare providers more precise tools to detect and manage coronary artery disease, ultimately leading to better patient outcomes and more personalized care.
With AI-powered solutions gaining wider acceptance and coverage, healthcare organizations are poised to harness the full potential of these innovations, marking a turning point in the fight against cardiovascular disease.
