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Coding and
Reimbursement Guide
Fractional Flow Reserve derived from
Computed Tomography (FFRCT)
January 2018
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| Redwood City, CA 94063
ph: +1.650.241.1221
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Introduction
The Fractional Flow Reserve Computed Tomography (FFRCT)
Coding Guide is intended to provide reference material related
to the reimbursement of the FFRCT procedure when used
consistently with the product’s labeling.
Disclaimer
The information provided in this document is general information only and is not provided as legal advice, nor is it advice about
how to code, complete, or submit any particular claim for payment for health care services or goods. This information provides
only an overview of HeartFlow’s understanding of current coding policies, and may not provide all the information necessary to
understand a particular situation. The information provided may not be comprehensive or complete. It is the responsibility of the
health care provider, such as a hospital or a physician, to submit complete, accurate and appropriate bills or claims for payment
that comply with applicable laws and regulations and third-party payer requirements, and to determine the appropriate codes,
charges, and modifiers that the provider uses for those purposes. Third-party payers may have policies and coding requirements
that differ from those described here, and such policies can change over time.
HeartFlow disclaims any responsibility for claims submitted by health care physicians or others. Physicians should check and verify
current policies and requirements with the payer for any particular patient. HeartFlow endorses the best practice that all coding
and billing submissions to payers be truthful and not misleading, and that providers make full disclosures to the payer about how
the service has been used. This reimbursement and coverage guide is not intended to provide specific guidance on how to utilize,
code, bill, or charge for any product. HeartFlow cannot guarantee success in obtaining payment for products and services.
CPT Copyright 2018 American Medical Association. All rights reserved. CPT® is a registered trademark of the American
Medical Association.
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Coding for FFRCT
These coding suggestions do not replace seeking coding advice from the payer and/or your own coding staff.
The ultimate responsibility for correct coding lies with the provider of services. The medical record must include
documentation to support the medical necessity of the procedure and the diagnosis and procedure codes
selected to report the service.
CPT® Code1
Description
Noninvasive estimated coronary fractional flow reserve (FFR) derived from coronary
computed tomography angiography data using computation fluid dynamics physiologic
simulation software analysis of functional data to assess the severity of coronary artery
0501T
disease; data preparation and transmission, analysis of fluid dynamics and simulated
maximal coronary hyperemia, generation of estimated FFR model, with anatomical
data review in comparison with estimated FFR model to reconcile discordant data,
interpretation and report
0502T
data preparation and transmission
analysis of fluid dynamics and simulated maximal coronary hyperemia, and
0503T
generation of estimated FFR model
anatomical data review in comparison with estimated FFR model to reconcile
0504T
discordant data, interpretation and report
• Report 0501T, 0502T, 0503T, 0504T one time per coronary CT angiogram
• Do not report 0501T in conjunction with 0502T, 0503T, 0504T
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Coding and
Reimbursement for FFRCT
Hospital Outpatient2
In the calendar year 2018 hospital Outpatient Prospective Payment (OPPS) rulemaking, the Centers for Medicare
& Medicaid Services (CMS) determined that FFRCT should be separately payable under the OPPS, assigning CPT
code 0503T to New Technology Ambulatory Payment Classification (APC) 1516, with a national payment rate
of $1450.50. A New Technology APC is intended to provide payment under the OPPS for complete services or
procedures that cannot be appropriately reported by existing Healthcare Common Procedure Coding System
(HCPCS) codes assigned to a clinical APC or be reported by a new HCPCS code that could be assigned to an
existing APC.
CPT®
Status
National
Description
APC
Code1
Indicator
Medicare Rate
Noninvasive estimated coronary fractional flow reserve
(FFR) derived from coronary computed tomography
angiography data using computation fluid dynamics
physiologic simulation software analysis of functional
data to assess the severity of coronary artery disease;
Not paid under
M
N/A
0501T
data preparation and transmission, analysis of fluid
OPPS
dynamics and simulated maximal coronary hyperemia,
generation of estimated FFR model, with anatomical
data review in comparison with estimated FFR model
to reconcile discordant data, interpretation and report
data preparation and transmission
N
N/A
Packaged
0502T
analysis of fluid dynamics and simulated maximal
coronary hyperemia, and generation of estimated
S
1516
$1,450.50
0503T
FFR model
anatomical data review in comparison with
Not paid under
0504T
estimated FFR model to reconcile discordant
M
N/A
OPPS
data, interpretation and report
M = Items and services are not billable to N = Items and services packaged into
S = Significant procedure not subject to
the MAC. Not paid under OPPS.
APC rates. No separate APC payments.
multiple procedure discounting.
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Coding and
Reimbursement for FFRCT
Physician3
Category III CPT codes reflect emerging technologies, and there are not assigned Relative Value Units (RVUs)
for the calculation of physician payment. Medicare assigned XXX (the global concept does not apply) to all four
codes; payment is at the discretion of the applicable Medicare Administrative Contractor (MAC). Because there
is no assigned Medicare payment for Category III codes, physicians submitting a claim for the FFRCT Analysis are
advised to reference an existing service or procedure that is comparable to the FFRCT Analysis in terms of costs
and resources.
CPT®
Status
Work
National
Medicare Rate
Description
Code1
Indicator
RVU
Facility
Non Facility
Noninvasive estimated coronary fractional flow reserve
(FFR) derived from coronary computed tomography
angiography data using computation fluid dynamics
physiologic simulation software analysis of functional
data to assess the severity of coronary artery disease;
C
N/A
N/A
N/A
0501T
data preparation and transmission, analysis of fluid
dynamics and simulated maximal coronary hyperemia,
generation of estimated FFR model, with anatomical
data review in comparison with estimated FFR model
to reconcile discordant data, interpretation and report
0502T
data preparation and transmission
C
N/A
N/A
N/A
analysis of fluid dynamics and simulated maximal
coronary hyperemia, and generation of estimated
C
N/A
N/A
N/A
0503T
FFR model
anatomical data review in comparison with
0504T
estimated FFR model to reconcile discordant
C
N/A
N/A
N/A
data, interpretation and report
C = Carriers/MACs priced code. Carriers/MACs will establish RVUs and payment amounts for these services, generally on an
individual case-by-case basis following review of documentation such as an operative report.
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References
1
CPT Copyright 2018 American Medical Association. All rights reserved. CPT® is a registered trademark of the American Medical
Association. Please note that the use or reprinting of CPT content in any product or publication requires a license. For more
information about the licenses available, see CPT License Information . Applicable FARS/DFARS Restrictions Apply to Government
Use. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not
part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense
medical services. The AMA assumes no liability for data contained or not contained herein.
2
Hospital Outpatient Prospective Payment- Notice of Final Rulemaking (NFRM) with Comment Period. CMS-1678-FC:
3
CY 2018 Revisions to Payment Policies under the Physician Fee Schedule and Other Revisions to Part B. CMS-1676-F:
6
HeartFlow, Inc.
| Coding and Reimbursement Guide
| January 2018
HeartFlow logo
1400 Seaport Blvd, Bldg B
| Redwood City, CA 94063
ph: +1.650.241.1221
15995572 v2