New Reimbursement Unlocks AI-Powered Heart Disease Diagnosis for Millions

BOSTON, MA – January 09, 2026 – A seismic shift in cardiovascular care is underway as new reimbursement policies and a dedicated billing code have opened the door for millions of Americans to access advanced, AI-powered analysis of coronary artery plaque. Effective January 1, 2026, a new Category I Current Procedural Terminology (CPT®) code, combined with widespread coverage from the nation’s largest private insurers, has created a clear pathway for the adoption of technologies designed to predict and prevent heart attacks with unprecedented precision.

This development marks a critical turning point for companies like Boston-based Elucid, whose Plaque-IQ™ software is a key beneficiary. The changes validate quantitative coronary plaque analysis as an essential, rather than experimental, tool in the fight against heart disease, the leading cause of death globally.

A New Era of Access and Reimbursement

The most significant catalyst for this change is the establishment of CPT code 75577 by the American Medical Association (AMA). Its transition from a provisional Category III code to a permanent Category I designation signifies that the procedure is now considered a standard clinical service, supported by sufficient evidence of its effectiveness. This move provides a standardized way for physicians and hospitals to bill for the sophisticated software-based analysis of a coronary computed tomography angiography (CCTA) scan.

Financially, the new code carries substantial weight. The Centers for Medicare & Medicaid Services (CMS) has set the 2026 national average payment at $1,012 for use in imaging centers and physician offices, and $951 in hospital outpatient settings. These robust reimbursement rates provide a strong financial incentive for healthcare providers to integrate the technology into their diagnostic workflows.

Complementing the new CPT code is a wave of positive coverage decisions from major health insurers. Aetna recently joined Humana, Cigna, and UnitedHealthcare in covering coronary plaque analysis, a move that aligns with updated guidelines issued by radiology benefit manager Evicore in July 2025. Collectively, these policies mean that more than 70 percent of commercially insured Americans now have access to this advanced diagnostic, dramatically expanding its reach beyond academic medical centers and into community hospitals and clinics nationwide.

Beyond Blockages: The Science of Precision Plaque Analysis

For decades, the primary focus of cardiac imaging has been on identifying stenosis, or the narrowing of an artery. While significant blockages are a clear cause for concern, a large number of heart attacks are caused by plaques that are not severely flow-limiting but are unstable and prone to rupture. The new generation of AI-powered software aims to address this gap by characterizing the plaque itself.

Technologies like Elucid’s Plaque-IQ go beyond simply measuring the size of a blockage. They use sophisticated algorithms to analyze CCTA scans and quantify the specific components of atherosclerotic plaque, such as fibrous tissue, calcium, and, most critically, lipid-rich necrotic core (LRNC). LRNC is a key feature of high-risk, vulnerable plaques that are more likely to rupture and cause a heart attack or stroke.

What sets Elucid’s technology apart in a growing field is its validation method. While many competitors validate their software against other imaging modalities like intravascular ultrasound (IVUS), Elucid’s Plaque-IQ is the only technology of its kind validated against ground truth histology—the microscopic analysis of actual plaque tissue by pathologists. This is considered the gold standard for tissue characterization and gives physicians a higher degree of confidence that what the software identifies as high-risk plaque corresponds to biological reality.

“Plaque analysis is quickly becoming an essential tool in my overall patient diagnosis and management, and its adoption will only accelerate as coverage continues to expand,” said Victor Marinescu, MD, a cardiologist at Midwest Cardiovascular Institute in Naperville, Illinois. “I’m particularly intrigued by Elucid‘s histology-based technology and Plaque-IQ’s ability to identify lipid rich necrotic core (LRNC). This additional insight is influencing my diagnostic decisions and shaping how I manage patient care.”

Navigating a Competitive and Evolving Market

The establishment of broad reimbursement has intensified the competitive landscape for cardiovascular diagnostics, a market projected to see explosive growth. The global market for AI in medical imaging was valued at $1.2 billion in 2023 and is forecasted to surge to $11.7 billion by 2033. Elucid finds itself among a handful of innovative companies, including HeartFlow, Cleerly, and Caristo Diagnostics, all vying to set the standard for noninvasive plaque analysis.

Each company touts its unique technological advantages and clinical data, creating a dynamic environment that is accelerating innovation. The vendor-agnostic nature of some new insurance policies, which cover any FDA-cleared plaque quantification software meeting clinical criteria, suggests that payers are endorsing the entire category of technology, fostering competition based on performance and clinical utility.

Investor confidence in this sector remains high. Elucid, for instance, has successfully raised $163 million in total funding, including a significant $80 million Series C round in late 2023. This capital is being deployed to scale commercial operations and further develop its product pipeline, demonstrating a clear strategy to capitalize on the newly favorable market conditions.

Standardizing the Future of Cardiac Imaging

The rapid adoption of AI-driven plaque analysis is not happening in a vacuum. It is supported by a growing consensus within the medical community. Leading professional organizations, including the Society of Cardiovascular Computed Tomography (SCCT), the American College of Cardiology (ACC), and the American Heart Association (AHA), have all published expert consensus statements and guidelines. These documents provide a framework for standardizing how the technology is used, interpreted, and reported, ensuring its responsible integration into clinical practice.

This convergence of technological advancement, regulatory approval, and clinical validation represents a paradigm shift toward more personalized and preventative medicine. By equipping physicians with a detailed understanding of a patient's actual disease burden, rather than relying solely on population-based risk scores, these tools empower more tailored treatment strategies, from lifestyle changes and aggressive medical management to precisely planned interventions.

“Elucid has long been committed to advancing clinically meaningful imaging analytics that support physician decision-making,” said Elucid CEO Kelly Huang, PhD. “The scope, scale and speed of these reimbursement changes are unprecedented, and highlight the clinical value that CT-derived coronary plaque analysis brings to physicians and their patients. These advances reinforce our belief that Plaque-IQ helps physicians make patient-specific decisions around medical management and intervention.”

As these tools become embedded in the standard of care, the focus of cardiology may continue to evolve from reacting to cardiovascular events to proactively identifying and stabilizing the high-risk disease that causes them, potentially saving countless lives.