The U.S. Centers for Medicare & Medicaid Services (CMS) has finalized reimbursement under the Hospital Outpatient Prospective Payment System (HOPPS) for Caristo Diagnostics’ CaRi-Plaque, an AI-assisted coronary plaque analysis for coronary CT angiography (CCTA) scans.
The CMS recently set a 2026 Physician Fee Schedule (PFS) payment rate of more than $1,000 for CaRi-Plaque analysis in physician offices and imaging centers based on a new Category I CPT code (75577) for AI quantification and characterization of coronary atherosclerotic plaque derived from analysis of CCTA.
With the establishment of a $950.50 companion OPPS payment rate, the two major Medicare reimbursement pathways for nationwide use of CaRi-Plaque are now complete, Caristo said.
Under the new ruling, hospitals can bill Medicare for CaRi-Plaque beginning January 1, 2026, when the new Category I CPT code (75577) and 2026 OPPS and PFS payment rates will all take effect.
Caristo added that it is currently working with hospitals and imaging centers across the U.S. to support CaRi-Plaque integration and prepare for 2026 billing.
