What's Happening?
UnitedHealthcare has announced an update to its cardiac imaging guidelines, which will now include coverage for Elucid's PlaqueIQ coronary computed tomography angiography (CTA) plaque quantification starting October 1, 2025. This decision aligns with recommendations from radiology benefit manager EviCore and marks a significant advancement for Elucid, a company specializing in AI-driven cardiac imaging technology. PlaqueIQ is the first FDA-cleared, non-invasive plaque analysis tool that provides automated quantification and classification of plaque morphology. It is particularly adept at identifying lipid-rich necrotic core plaques, which are closely associated with cardiovascular risk. This technology enables physicians to move beyond generalized risk assessments and develop personalized care pathways for patients with coronary artery disease, potentially reducing the risk of future cardiac events such as heart attacks and strokes.
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Why It's Important?
The inclusion of Elucid's PlaqueIQ in UnitedHealthcare's coverage is a pivotal development in the field of cardiac care, as it expands access to advanced imaging technologies that can significantly enhance patient outcomes. By allowing for more precise and personalized treatment plans, this coverage could lead to better management of coronary artery disease, ultimately reducing the incidence of severe cardiac events. The policy change is part of a broader trend towards personalized medicine, which aims to tailor healthcare to individual patient needs. This move also reflects a growing recognition of the importance of advanced diagnostic tools in improving healthcare delivery and outcomes, particularly in non-urban areas where access to such technologies has been limited.
What's Next?
A new Category I code for coronary plaque analysis will be implemented on January 1, 2026, further supporting the expanded coverage and access to Elucid's PlaqueIQ technology. This code will facilitate broader adoption of the technology across healthcare providers, enabling more patients to benefit from personalized cardiac care. Additionally, the recent CMS rule that increased reimbursement rates for cardiac CT scans is expected to encourage more hospitals and outpatient clinics to offer these services, thereby reducing disparities in care. As more Medicare Administrative Contractors extend coverage for PlaqueIQ, the technology will become accessible to a larger portion of the Medicare population, further driving its adoption and impact.
