CPT 75577 Is Live: What Insurance Teams Need to Update Now
As of January 1, 2026, AI-enabled quantification and characterization of coronary atherosclerotic plaque derived from CCTA is reimbursed under permanent Category I CPT code 75577. This new code replaces prior Category III codes and carries national valuation across hospital outpatient departments, imaging centers, and physician offices.
Major commercial payers - including Aetna, UnitedHealthcare, Cigna, Humana, and others - have confirmed coverage. This extends access to tens of millions of members and will push more CCTA-based plaque assessment into routine care.
Immediate Actions for Payers
- Load CPT 75577 into fee schedules and claims editing systems with correct site-of-service settings (HOPD, freestanding imaging, physician office).
- Publish coverage criteria aligned to current cardiology guidance: use quantitative plaque analysis when coronary CTA shows visual evidence of plaque and results will inform risk assessment or preventive therapy decisions.
- Define documentation standards: include the source CCTA, AI plaque metrics (burden and composition), lesion/vessel summaries, and physician oversight/interpretation.
- Clarify billing rules: when 75577 may be reported alongside the base coronary CTA, bundling considerations, and any NCCI edit alignment.
- Set utilization controls: prior authorization thresholds, frequency limits per member, and repeat testing rules (e.g., minimum intervals).
- Specify provider qualifications: facility accreditation, imaging protocol quality, and physician training for interpretation of quantitative plaque metrics.
- Add post-pay review triggers to prevent duplicate billing (provider vs. third-party AI service) and to verify medical necessity.
Clinical Guidance to Anchor Policy
A December 2025 scientific statement in JACC: Cardiovascular Imaging recommended quantitative coronary plaque analysis among patients with visual plaque on coronary CTA to refine risk and guide initiation or intensification of preventive therapies. That direction provides a clear medical necessity baseline for coverage and audits.
Why the Category I Transition Matters
Category I status stabilizes payment and signals that the service has sufficient evidence and utilization. Expect increased ordering of CCTA with plaque analysis, more standardized reporting, and a shift of some members from stress-only testing to CTA-first pathways when appropriate.
Operational Coding and Documentation Notes
- Use CPT 75577 for AI-driven quantification and characterization of coronary plaque derived from a CCTA study.
- Medical records should show: visual plaque on the source CTA, quantitative outputs (e.g., plaque burden and composition), and how results informed risk stratification or therapy decisions.
- Require a signed physician report confirming review, any manual adjustments to contours, and final interpretation.
- Establish bundling rules with the base CTA code per payer policy and maintain clear edits to avoid unbundling or duplicate charges.
On-Premise AI, Cleaner Claims
Circle Cardiovascular Imaging's FDA-cleared cvi 42 |Plaque runs on-premise, inside the institution's environment. It auto-segments the coronary lumen and vessel wall, quantifies plaque burden and composition, and outputs structured, lesion- and vessel-level metrics that fit existing CCTA workflows.
Because processing and reporting happen locally, physicians retain interactive control over contouring and final reads. Programs also avoid outsourced, cloud-only service fees - which reduces the risk of split billing between a provider and a third-party vendor.
- Expect claims for 75577 to originate from the imaging provider/facility rather than an external AI vendor.
- On-prem workflows simplify PHI governance, audit trails, and site credentialing.
"With the new Category I CPT code for coronary plaque analysis now in effect, and the major insurance players reimbursing plaque analysis, the economics and clinical evidence are finally aligned," said Chris Bazinet, Chief Commercial Officer at Circle CVI.
Policy Language Checklist
- Indications: members with visual coronary plaque on CCTA where quantitative results guide risk assessment or preventive therapy.
- Non-indications: no visual plaque on CCTA; scenarios where results will not alter management.
- Documentation: source CCTA identifiers, quantitative metrics, structured report, and physician interpretation.
- Frequency: define reasonable intervals for follow-up assessments based on risk and therapy changes.
- Site-of-service: allow in HOPD, imaging centers, and physician offices that meet accreditation and equipment standards.
- Prior auth: consider streamlined approval when criteria and documentation templates are met.
- Quality: require adherence to recognized CCTA acquisition standards and reporting consistency.
CCTA's Expanding Role in CAD Management
As reimbursement stabilizes and AI plaque analysis becomes routine, CCTA is positioned as a frontline modality for diagnosing and managing coronary artery disease. It characterizes both stenosis and atherosclerotic burden, helping clinicians intensify prevention earlier and potentially reduce downstream invasive procedures when not indicated.
About Circle Cardiovascular Imaging
Circle Cardiovascular Imaging Inc. (Circle CVI) develops software that enhances cardiovascular and cerebrovascular imaging analysis. Its cvi 42 platform provides image reading and reporting for cardiac MR, cardiac CT, vascular CT, and neuro CT. Millions of exams each year - across 1,700+ hospitals in over 90 countries - are interpreted using cvi 42.
For media inquiries, please contact: marketing@circlecvi.com
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