Oxford, UK – December 12, 2024 – Ultromics announced today that CMS has released the final OPPS rules in the Federal Register. As anticipated, CMS has assigned the new Category III CPT code 0932T to APC 5743, with a reimbursement rate of $299.91. The assignment to a clinical APC highlights Medicare’s confidence in the robust clinical validation of Ultromics’ technology, underscoring the value of the data and its impact on heart failure care.
This clinical APC code and rate will be effective on January 1, 2025, enabling reimbursement in the outpatient setting for every patient with heart failure with preserved ejection fraction (HFpEF) whose diagnosis report is returned by EchoGo® Heart Failure. This marks a significant advancement in the accessibility of Ultromics' innovative technology. The APC assignment is for payment purposes only, and clinicians will still need to bill under the new CPT code 0932T starting January 1, 2025.
EchoGo® Heart Failure uses AI to detect HFpEF from a single, routinely acquired echocardiographic video. The technology leverages advanced algorithms to identify suspected disease that may go undetected by traditional diagnostic methods. These AI-driven insights support clinicians in diagnosing and managing this challenging subtype of heart failure.
EchoGo® Heart Failure is part of Ultromics' EchoGo® platform, which also includes EchoGo® Amyloidosis, providing a comprehensive solution for diagnosing heart failure and its underlying causes. This combined approach enhances diagnostic accuracy, enables systematic screening, and supports timely access to potentially life-saving therapies.
The revised Medicare payment to hospital outpatient departments for this service will provide better support for healthcare facilities using this groundbreaking technology, facilitating broader patient access in outpatient settings.
The assignment of CPT code 0932T to APC 5743 will replace the previous outpatient HCPCS code C9786 for EchoGo® Heart Failure. EchoGo® Heart Failure is also covered in the hospital inpatient setting under the New Technology Add-on Payment (NTAP) code XXE2X19. This move reflects Ultromics' continued commitment to revolutionizing cardiovascular care and solidifies its leadership in the field.
Ross Upton, PhD, Chief Executive Officer and founder of Ultromics, stated, "This recognition by CMS underscores the significant impact our technology is having in the field of heart failure care. HFpEF represents a significant and growing patient population, accounting for 50% of heart failure cases worldwide, with up to 64% of these cases potentially going undiagnosed. We believe that EchoGo® Heart Failure will transform diagnostic pathways for these patients, supporting the detection of patients suffering from this disease, providing an opportunity for earlier intervention, and delivering benefits to payers and healthcare systems."
EchoGo® modules for HFpEF and Cardiac Amyloidosis detection are FDA-cleared and readily available to healthcare providers across the United States. The updated assignment will take effect on January 1, 2025.
For more information about EchoGo® and to learn about how it can benefit your practice, please visit our homepage.
For comprehensive information, including the code's official long descriptor and status indicator, please see the OPPS final rule here.
