ABSTRACT
Introduction: Over the past decade, through numerous technical advances and clinical studies, cardiovascular computed tomography (CCT) has gained increasing acceptance;recently evidenced by receiving multiple class 1, level A recommendations in the 2021 AHA/ACC Chest Pain Guidelines. We aimed to evaluate recent CCT practice and practitioner trends in the US Medicare population with the motivation of guiding practice, training, and advocacy. Methods: A retrospective cross-sectional analysis of Medicare Part B pay-for-service physician payments was performed between 2013-2020. CCT/FFRCT exams and providers were identified by unique HCPCS codes. Providers, exams, cost, and payment denials were analyzed. Medical specialty, gender, and geo-location of providers were summarized. Results: From 2013 to 2019, the number of providers of CCT exams and the number of exams increased significantly. Providers of CAC scoring increased >210%. Providers of coronary CTA in the hospital setting increased 36% and in independent testing facilities by 9%. CAC scoring exams increased 724% and coronary CTA exams increased 126% (see Figure). In the first year of the COVID-19 pandemic (2020), CAC scoring usage decreased by -9.3% and coronary CTA by -3.3%. Since initial reimbursement in 2018, FFRCT usage has increased by 654% but was applied in only 4% of coronary CTA exams. In 2020, contrary to a moderate CCT exam decline, FFRCT analysis increased by 376% compared to the previous year. Medicare insurance acceptance of cardiac CT became more favorable into 2020 (see Figure). CAC scoring denials decreased from 61.6% to 33.2% and coronary CTA denials decreased slightly from 7.3% to 6.4%. FFRCT denials decreased significantly from 64% to 6%. In 2019, 30.5% of CCT providers were cardiologists with the remainder being predominantly radiologists. On the other hand, 76.2% of FFRCT providers were cardiologists. A slightly lower percentage of FFRCT billing physicians were female compared to CCT billing physicians (14.2% vs 17.9%). CA, NY, MN, TX, and PA had the highest FFRCT utilization. Conclusions: In general, both CAC scoring and coronary CTA utilization have increased, along with a large increase in the utilization of FFRCT over the study time period. This increase in utilization was accompanied by a significant increase in providers and a decrease in reimbursement denials. In the first year of the COVID-19 pandemic, CCT usage was robust and only decreased moderately. [Formula presented]