Billing guidelines
For Cleerly's coronary artery disease analysis
2026 Plaque coding
and Medicare allowable reimbursement
CPT® Code1
-
75577
Physician Fee Schedule
CPT® Description
Quantification and characterization of coronary atherosclerotic plaque to assess severity of coronary disease, derived from augmentative software analysis of the data set from a coronary computed tomographic angiography, with interpretation and report by a physician or other qualified health care professional.
Office CPT® Code 1 Total RVU* Payment Non-Qualifying Payment Qualifying 75577 30.30 $1012.05 $1017.10 75577-TC 29.06 $970.63 $975.47 75577-26 1.24 $41.42 $41.62
* Total RVU (Relative Value Unit) is the sum of work expense, practice expense and malpractice expense RVUsFacility CPT® Code 1 Total RVU* Payment Non-Qualifying Payment Qualifying 75577 NA NA NA 75577-TC NA NA NA 75577-26 1.24 $41.42 $41.62
PFS Qualifying APM Conversion Factor: 33.5675
PFS Non-Qualifying APM Conversion Factor: 33.4009Hospital Outpatient
CPT® Description
Quantification and characterization of coronary atherosclerotic plaque to assess severity of coronary disease, derived from augmentative software analysis of the data set from a coronary computed tomographic angiography, with interpretation and report by a physician or other qualified health care professional.
**Status Indicator "S" indicates procedure or service not subject to multiple procedure discountingOPPS (Outpatient Prospective Payment System) CPT® Code 1 Status Indicator** APC Payment 75577 S 1511 $950.50
Plaque ICD-10-CM
-
ICD-10-CM codes that support medical necessity 2
ICD-10 Code ICD-10 Description R 93.1 Abnormal findings on diagnostic imaging of heart and coronary circulation -
Commonly used ICD-10-CM codes for coronary artery disease (CAD)
ICD-10 Code ICD-10 Description R 07.1 Chest pain on breathing R 07.2 Precordial pain R 07.81 Pleurodynia R 07.82 Intercostal pain R 07.89 Other chest pain R 07.9 Chest pain, unspecified R 06.02 Shortness of breath I 20.0 Unstable angina I 25.10 Atherosclerotic heart disease of native coronary artery without angina pectoris I 25.110 Atherosclerotic heart disease of native coronary artery with unstable angina pectoris I 25.111 Atherosclerotic heart disease of native coronary artery with angina pectoris with documented spasm I 25.112 Atherosclerotic heart disease of native coronary artery with refractory angina pectoris I 25.118 Atherosclerotic heart disease of native coronary artery with other forms of angina pectoris I 25.119 Atherosclerotic heart disease of native coronary artery with unspecified angina pectoris I 25.6 Silent myocardial ischemia I 25.751 Atherosclerosis of native coronary artery of transplanted heart with angina pectoris with documented spasm
2026 ISCHEMIA coding
and Medicare allowable reimbursement
CPT® Code
-
75580
Physician Fee Schedule
CPT® Description
Noninvasive estimate of coronary fractional flow reserve derived from augmentative software analysis of the data set from a coronary computed tomography angiography, with interpretation and report by a physician or other qualified health care professional.
Office CPT® Code 1 Total RVU* Payment Non-Qualifying Payment Qualifying 75580 26.55 $886.79 $891.22 75580-TC 25.52 $852.39 $856.64 75580-26 1.03 $34.40 $34.57
* Total RVU (Relative Value Unit) is the sum of work expense, practice expense and malpractice expense RVUsFacility CPT® Code 1 Total RVU* Payment Non-Qualifying Payment Qualifying 75580 NA NA NA 75580-TC NA NA NA 75580-26 1.03 $34.40 $34.57
PFS Qualifying APM Conversion Factor: 33.5675
PFS Non-Qualifying APM Conversion Factor: 33.4009Hospital Outpatient
CPT® Description
Noninvasive estimate of coronary fractional flow reserve derived from augmentative software analysis of the data set from a coronary computed tomography angiography, with interpretation and report by a physician or other qualified healthcare professional.
**Status Indicator "S" indicates procedure or service not subject to multiple procedure discountingOPPS (Outpatient Prospective Payment System) CPT® Code 1 Status Indicator** APC Payment 75580 S 5724 $877.34
ISCHEMIA ICD-10-CM
-
Commonly used ICD-10-CM codes
ICD-10 Code ICD-10 Description R 93.1 Abnormal findings on diagnostic imaging of heart and coronary circulation I 20 Angina pectoris I 21 Acute myocardial infarction I 24 Other acute ischemic heart diseases I 25 Chronic ischemic heart disease I 25.6 Silent myocardial ischemia
Commercial payment will vary and is at the discretion of the payor. Other specific diagnosis codes may also apply. Total RVU (Relative Value Unit) is the sum of work, practice expense and malpractice RVU.
Sources
CMS. CY 2026 Hospital Outpatient Prospective Payment (OPPS) and Ambulatory Surgical Center (ASC) Payment Systems Final Rule: CMS-1834-FC, including related addenda. Effective through December 31, 2026. https://www.cms.gov/medicare/payment/prospective-payment-systems/ambulatory-surgical-center-asc/asc-regulations-and/cms-1834-fc
CMS. CY 2026 MPFS Final Rule (CMS-1832-F) - Addendum B Relative Value Units and Related Information Used in Determining Medicare Payments.. https://www.cms.gov/medicare/payment/fee-schedules/physician/federal-regulation-notices/cms-1832-f
Medicare Advantage
Effective January 1, 2024, CMS mandated that Medicare Advantage plans align their coverage and site of service with Medicare Fee-for-Service (FFS) guidelines. CMS implements important utilization management policy and coverage criteria protections to ensure Medicare Advantage enrollees receive the same access to medically necessary care that they would receive in Traditional Fee for Service Medicare.
https://www.cms.gov/newsroom/fact-sheets/2024-medicare-advantage-and-part-d-final-rule-cms-4201-f
Additional information3
- Report Coronary Computed Tomographic Angiography (CCTA) separately with CPT® code 75574
Modifiers
- Modifier "26" is defined as "Professional Component" and should be appended to a procedure code when the provider rendered only the professional component of the service.6
- Modifier "TC" is defined as "Technical Component" and should be appended to a procedure code when the provider rendered only the technical component of the service.6
References
1 2026 Current Procedural Terminology (CPT®) Professional Edition. CPT® is a registered trademark of the American Medical Association. All rights reserved.
2 Centers for Medicaid and Medicaid Services (CMS) Billing and Coding Articles: Artificial Intelligence Enabled CT Based Quantitative Coronary Topography (AI-QCT)/Coronary Plaque Analysis (AI-CPA)
Cleerly Heart Analysis may include analysis performed using Cleerly Labs and/or Cleerly Ischemia. Cleerly Labs is a web-based software application that is intended to be used by trained medical professionals as an interactive tool for viewing and analyzing cardiac computed tomography (CT) data for determining the presence and extent of coronary plaques (i.e., atherosclerosis) and stenosis in patients who underwent Coronary Computed Tomography Angiography (CCTA) for evaluation of coronary artery disease (CAD) or suspected CAD. Cleerly Ischemia is a web-based software application feature that is designed to estimate the likely presence and/or likely absence of ischemia in patients who have undergone CCTA for further assisting evaluation of CAD or suspected CAD.
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