Malmö, Sweden — Acarix, a leader in rapid AI and acoustics-based cardiac diagnostics, announced today that the U.S. Centers for Medicare & Medicaid Services (CMS) has decided that the CPT code 0716T – the CADScor® System – shall be assigned to APC 5733 including status indicator assignment to “S” (separately payable) for calendar year 2025. The CMS ruling means standalone fixed reimbursement is now possible for the CADScor System in outpatient settings.
“Locking in guaranteed reimbursement for the CADScor System is a huge win for Acarix and will allow for rapid growth throughout the U. S. in a multitude of healthcare settings,” said Aamir Mahmood, Acarix President and CEO. “Having a fixed CADScor reimbursement as a standalone service rather than packaged in a ‘global code’ with other diagnostic tests will give us a clear sight as demand for and usage of the CADScor System accelerates in the U. S.”
CMS’s decision means that when the CADScor System is used in the APC/outpatient setting, including in emergency rooms (ER) and ambulatory surgery centers (ASC), it will be paid. This “S” code will give healthcare providers the ability to submit reimbursement claims via their standard billing processes.
“The certainty of payment that comes with CMS’s “S” code decision will greatly accelerate CADScor System usage in ER and ambulatory settings throughout the U. S.,” said Dr. George Chrysant, Chief Medical Officer for INTEGRIS Health Heart Hospital/INTEGRIS Health Cardiovascular Physicians in Oklahoma City, OK. “This decision shows that CMS sees CADScor as a first-in-class product and I am very pleased CMS has already committed to re-evaluate the reimbursement rate once the system is in widespread use, which we are confident will happen in 2025.”
This CMS decision will likely also influence pending private payer reimbursement decisions, as CMS is looked to for guidance as the first step to ensuring secured payment.
“This decision will have a domino effect on private payers across the U. S.,” said Mahmood. “This is what we have been waiting for to really accelerate growth in the U. S. market and get this new technology in the hands of more doctors across the country.”
The Acarix CADScor is a non-invasive, radiation free diagnostic aid powered by AI to rule out Coronary Artery Disease (CAD) with 97% accuracy in less than 10 minutes. The CADScor System is CE- and FDA-cleared, covered by more than 40 patents and used on over 40,000 patients with symptomatic chest pain.