Billing guidelines
For Cleerly's coronary artery disease analysis
2025 Plaque coding
and Medicare allowable reimbursement
CPT® Code1
-
0623T
CPT® Description
Automated quantification and characterization of coronary atherosclerotic plaque to assess severity of coronary disease, using data from coronary computed tomographic angiography; data preparation and transmission, computerized analysis of data, with review of computerized analysis output to reconcile discordant data, interpretation, and report.
Physician Fee Schedule
RVUs Facility Non-Facility Carrier Priced Carrier Priced Carrier Priced Hospital Outpatient
Status Indicator APC Payment M N/A N/A -
0624T
CPT® Description
Automated quantification and characterization of coronary atherosclerotic plaque to assess severity of coronary disease, using data from coronary computed tomographic angiography, data preparation and transmission.
Physician Fee Schedule
RVUs Facility Non-Facility Carrier Priced Carrier Priced Carrier Priced Hospital Outpatient
Status Indicator APC Payment N N/A N/A -
0625T
CPT® Description
Automated quantification and characterization of coronary atherosclerotic plaque to assess severity of coronary disease, using data from coronary computed tomographic angiography, computerized analysis of data from coronary computed tomographic angiography.
Physician Fee Schedule
RVUs Facility Non-Facility Carrier Priced Carrier Priced Carrier Priced Hospital Outpatient
Status Indicator APC Payment S 1511 $950.50 -
0626T
CPT® Description
Automated quantification and characterization of coronary atherosclerotic plaque to assess severity of coronary disease, using data from coronary computed tomographic angiography; review of computerized analysis output to reconcile discordant data, interpretation, and report.
Physician Fee Schedule
RVUs Facility Non-Facility Carrier Priced Carrier Priced Carrier Priced Hospital Outpatient
Status Indicator APC Payment N/A N/A N/A
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/td>
2025 Ischemia coding
and Medicare allowable reimbursement
CPT® Code
-
75580
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.
Physician Fee Schedule
Modifier RVUs Facility Non-Facility N/A 25.94 N/A $839.07 TC 24.90 N/A $805.43 26 1.04 $33.64 $33.64 Status Indicator APC Payment N/A 5724 $1017.39
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. CPT® 75580 relevant revenue code: 0480
Sources
CMS. CY 2025 MPFS Final Rule (CMS-1807-F) - Addendum B Relative Value Units and Related Information Used in Determining Medicare Payments. Conversion Factor used in calculations = $32.3465. Effective through December 31, 2025.
https://www.cms.gov/medicare/payment/fee-schedules/physician/federal-regulation-notices/cms-1807-f
CMS. CY 2025 Hospital Outpatient Prospective Payment (OPPS) and Ambulatory Surgical Center (ASC) Payment Systems Final Rule: CMS-1809-FC, including related addenda. Effective through December 31, 2025.
https://www.cms.gov/medicare/payment/prospective-payment-systems/ambulatory-surgical-center-asc/asc-regulations-and/cms-1809-fc
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
- Use 0623T, 0624T, 0625T, 0626T one time per Coronary Computed Tomographic Angiography (CCTA)
- Do not report 0623T in conjunction with 0624T, 0625T, 0626T
- Do not report 0623T, 0624T, 0625T, 0626T in conjunction with CPT® code 76376 or CPT® code 76377
- Per CMS Addendum B of the October 2022 OPPS Update, 0625T has been reassigned from status indicator E1 to S and assigned to APC 1511 (New Technology - Level 11) effective October 1, 2022.4
Modifiers
- The Centers for Medicare & Medicaid Services (CMS) developed the National Correct Coding Initiative (NCCI) to promote national correct coding methodologies and to control improper coding leading to inappropriate payment.
- Effective July 1, 2022 providers can now utilize modifier -59 in order to bill CCTA and Cleerly Labs code (0623T-0626T) on the same date of service.5
- 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 2023 Current Procedural Terminology (CPT®) Professional Edition. CPT® is a registered trademark of the American Medical Association. All rights reserved.
2 https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=59733&ver=5
3 CPT® Assistant October 2021 / Volume 31 Issue 10
4 Centers for Medicare & Medicaid Services. October 2022 OPPS update. CR 12875, October 3, 2022 Integrated Outpatient Code Editor (I/OCE), page 6, table 6, addendum B.
6 Centers for Medicare & Medicaid Services. Medicare NCCI Procedure to Procedure (PTP) Edits, Practitioner PTP Edits v290r1. Effective Jan. 1, 2023; Posted Dec. 5, 2022.
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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