What's Happening?
Heartflow has achieved a significant milestone with Aetna updating its policies to cover Heartflow's AI-driven Plaque Analysis across all lines of business, effective December 23, 2025. This development is supported by the introduction of a new Category
I CPT code 75577, which provides a clear reimbursement pathway, establishing 4.00 total RVUs for the service. This marks a transition from the technology being considered experimental to becoming a standard of care. The American Medical Association (AMA) has officially converted Plaque Analysis to Category I CPT code 75577 as of January 1, 2026. This change allows hospitals to scale the technology profitably, with Aetna specifically covering patients with 1-69% stenosis identified on coronary CTA. The expansion is backed by the DECIDE Registry, a study involving approximately 22,000 patients, showing that adding Plaque Analysis to standard CCTA led to medical management changes in over 50% of patients.
Why It's Important?
The nationwide coverage by Aetna for Heartflow's AI Plaque Analysis represents a significant advancement in the integration of AI in healthcare, particularly in cardiology. This move not only validates the technology but also sets a precedent for other insurers, as UnitedHealthcare, Cigna, and Humana have also adopted similar coverage. The establishment of a clear reimbursement pathway with the new CPT code facilitates broader adoption and integration into clinical practice, potentially improving patient outcomes. The technology's ability to modify treatment plans and reduce cardiac event risks by 15% underscores its clinical value. This development could lead to a shift in how cardiovascular diseases are managed, emphasizing preventive care and personalized treatment strategies.
What's Next?
With major insurers on board, the focus for health systems will be on integrating Heartflow's technology into existing cardiology workflows to maximize the benefits of the new reimbursement structure. The challenge will be to train clinicians to effectively use the AI tool and distinguish between the cleared quantification tool and investigational risk-stratification models. As the technology becomes more widespread, further studies and real-world data will likely emerge, potentially expanding its applications and coverage criteria. The healthcare industry will need to address any operational challenges and ensure that the technology is accessible to a broad patient population.
Beyond the Headlines
The adoption of AI-driven technologies like Heartflow's Plaque Analysis raises important ethical and regulatory considerations. Ensuring patient data privacy and addressing potential biases in AI algorithms will be crucial as these technologies become more integrated into healthcare systems. Additionally, the shift towards AI in medical imaging may influence medical education and training, requiring new skill sets for future healthcare professionals. The long-term impact on healthcare costs and resource allocation will also need to be monitored, as the technology could lead to more efficient use of healthcare resources and potentially reduce the burden of cardiovascular diseases.
