- The proposed 2020 CMS Physician Fee Schedule (MFPS) and Hospital Outpatient Prospective Payment System (OPPS) rules issued a reduction in the technical component (TC) payment that would decrease reimbursement for cardiac CT codes by nearly 29% compared to the 2018 final rule. Cardiac CT codes are currently allocated to ambulatory payment classification (APC) 5571, which is used for level I imaging tests with contrast. However, cardiac CT exams utilize more resources and are very different in clinical scope.
- The authors nicely demonstrate,1 in a mixed cohort of asymptomatic and symptomatic patients, that the prevalence of non-calcified plaque is not insignificant among those persons with calcium score of zero. Understanding the differences between the symptomatic and asymptomatic cohorts are most important and that wasn't well delineated in the manuscript. Prevalence of disease, significance of non-calcified plaque and pre-test probability are all important factors that vary based on symptomatology.
- We would like to thank Dr. Kawada for his interest and effort spent to comment on our manuscript. He raises two interesting queries which we would like to respond to. His first query relates to the analysis of adverse outcome based upon quantified total plaque volume (TPV). All results presented in the manuscript were derived from Cox Regression Models. Due to the rather low number of events, the Framingham Score was incorporated into the multivariate analysis to avoid model overfitting and adjust for overall cardiovascular risk factors.