CPT Code 75577: 2026 Billing Guide for AI Coronary Plaque Analysis

CPT code 75577 is the permanent Category I code for AI coronary plaque analysis, effective January 1, 2026. The code reports software quantification and characterization of coronary atherosclerotic plaque from an existing coronary CT angiography (CCTA) data set, with a physician or qualified health care professional’s interpretation and report. It replaced 0623T through 0626T.

Medicare’s 2026 national amount for the global service is $1,012.05 under the physician fee schedule for non-qualifying APM participants, and hospital outpatient payment is $950.50. Coverage is narrow, though. A completed and interpreted CCTA comes first, the referring provider’s NPI belongs on the claim, and WPS and Palmetto list one diagnosis: R93.1.

You’ll find coverage rules, the documentation list, 2026 payment math, modifier scenarios, and denial fixes for the 75577 CPT code below. One O Seven RCM is a full-service revenue cycle management company in Fulshear, Texas. Our team runs the checks in this guide before releasing claims in our cardiology revenue cycle management work.

CPT 75577 at a glance (sources: AMA CPT 2026; CMS PFREV26C, July 2026; CMS OPPS 2026; WPS and Palmetto billing articles)

Element	2026 Detail
Code type	Permanent Category I, Radiology section
Effective date	January 1, 2026
Replaced	0623T, 0624T, 0625T, and 0626T
Service	AI plaque quantification and characterization from CCTA data, with interpretation and report
Reporting rule	Once per coronary CTA
Work RVU	0.85
PFS global (national)	$1,012.05 non-qualifying APM; $1,017.10 qualifying APM
Professional component (26)	$41.42 non-qualifying APM; $41.62 qualifying APM
Technical component (TC)	$970.63 non-qualifying APM; $975.47 qualifying APM
Hospital outpatient (OPPS)	APC 1511, status indicator S, $950.50
Medicare policy examples	WPS L39913 and A59813; Palmetto L39851 and A59721
Supporting ICD-10 (WPS, Palmetto)	R93.1
Claim must include	Referring or ordering physician name and NPI

What Is CPT Code 75577?

CPT 75577 reports software analysis of an existing CCTA data set that quantifies coronary plaque, characterizes its composition, and assesses the severity of coronary disease. A physician or other qualified health care professional reviews the output and issues the interpretation and report. No new scan happens under this code.

Official 75577 CPT Code Description

The CPT 75577 description published in the AMA’s 2026 code set is the wording payers and auditors hold your claim against:

“Quantification and characterization of coronary atherosclerotic plaque to assess severity of coronary disease, derived from augmentative software analysis of the data set from a coronary computed tomographic angiography, with interpretation and report by a physician or other qualified health care professional.” (CPT 2026 Professional Edition, copyright American Medical Association)

Four phrases in that wording matter most. Each one lines up with something in your chart or on the claim form, so your team should know what each one means in practice.

Descriptor element	What it means on the claim
“Quantification and characterization”	The software measures plaque volume and plaque composition.
“Assess severity of coronary disease”	This clinical purpose is what your medical necessity documentation has to support.
“Augmentative software analysis of the data set”	The software processes CCTA images that already exist, and the physician reviews the output.
“Interpretation and report”	A signed report from a physician or qualified health care professional is part of the code.

What Does AI Coronary Plaque Analysis Measure?

The purpose of procedure code 75577 is to report software measurement of how much plaque sits in the coronary arteries and what that plaque is made of. AMA’s CPT Assistant (February 2026, page 23) ties the intended use to assessing CAD severity or the risk of myocardial infarction in patients with CAD.

Medicare calls the service AI-QCT/AI-CPA: artificial intelligence enabled CT based quantitative coronary topography and coronary plaque analysis. Under WPS LCD L39913, the plaque analysis CPT code covers these outputs:

• Plaque burden, including total plaque volume and percent atheroma volume
• Calcified plaque, the higher density plaque mostly made of calcium
• Noncalcified plaque, including fibrotic plaque
• Low-attenuation plaque, which has higher lipid content
• Degree of stenosis in each coronary vessel

L39913 also defines high-risk plaque findings: the napkin-ring sign, low-attenuation plaque, positive vessel remodeling, and spotty calcification. Under the AMA’s AI taxonomy in CPT Appendix S, augmentative software analyzes or quantifies data in a clinically meaningful way, and a physician still interprets the output and signs the report.

Who Performs, Interprets, and Bills It?

CPT 75577 work usually involves three parties: the site that acquires the CCTA, the software that runs the analysis on site or through a cloud vendor, and the physician who interprets the output. All three rely on images from a previously performed CPT 75574 coronary CTA study.

L39913 requires software that’s FDA cleared or approved, and it requires interpreting physicians who are trained or credentialed in CCTA and AI-QCT/AI-CPA. Tools in this category include Cleerly, HeartFlow Plaque Analysis, Elucid PlaqueIQ, Caristo CaRi-Plaque, and Circle cvi42. Billing for each component follows whoever did that part of the work, which the modifier section below covers.

When Did CPT 75577 Take Effect, and What Did It Replace?

The CPT 75577 effective date is January 1, 2026. It replaced four Category III codes: 0623T, 0624T, 0625T, and 0626T. Claims for 2026 dates of service have to carry 75577, and the WPS and Palmetto billing articles were revised to match for dates of service from January 1, 2026.

The 0623T Through 0626T Crosswalk

The four T-codes split the service into pieces, and 75577 rolls them into one code. Use this crosswalk when you clean up old charge lines, authorization templates, or denied claims that still carry a deleted code.

Deleted code	What it covered	2026 reporting
0623T	Complete service: data preparation, transmission, computerized analysis, review, interpretation, and report	75577 (global)
0624T	Data preparation and transmission	75577 (technical portion)
0625T	Computerized analysis of the data	75577 (technical portion)
0626T	Review of the software output, interpretation, and report	75577-26

Splitting the technical and professional portions depends on whether the payer recognizes modifiers 26 and TC on 75577. Medicare publishes 2026 amounts for both components.

How the MACs Updated Their Billing Articles

WPS revised billing article A59813 (revision R1, posted January 29, 2026) to delete 0623T through 0626T and add 75577. Palmetto GBA made the same change in A59721, retroactive to January 1, 2026 dates of service. Palmetto’s FFR billing article A58406 also added 75577 in revision R4.

Two practical problems follow. A 2026 claim that still carries a T-code won’t process, and a prior authorization obtained under a T-code may not match the 75577 CPT line on the claim. If T-codes are still sitting in your charge master or authorization templates, you can catch them with a CPT-level billing audit before a payer does.

What Category I Status Changes, and What It Doesn’t

Category I status gives 75577 a permanent code, national RVUs, an OPPS payment assignment, and consistent reporting across payers. Coverage criteria, medical necessity rules, and prior authorization requirements stay the same. A payer can still deny a Category I code, and some plans added 75577 to their authorization lists in 2026.

The AMA’s CPT 2026 code set release lists 288 new codes, 84 deletions, and 46 revisions, and 75577 is one of the new CPT codes for 2026. Among those deleted CPT codes for 2026 are the four plaque analysis T-codes. For other cardiology changes, see ACC’s 2026 coding update and our 2026 cardiology CPT codes list.

How Does CPT Code 75577 Relate to 75574, 75580, 75571, and 75572?

Coronary CTA itself is reported with CPT 75574. Plaque analysis of that CCTA data set goes on 75577, once per CTA, and it doesn’t include the 75574 interpretation. For a CT-derived fractional flow reserve estimate (FFR-CT), you bill 75580, and noncontrast calcium scoring is 75571.

Cardiac CT Code Family at a Glance

The CCTA CPT code, 75574, anchors this family, and the 75573 CPT code covers congenital heart CT. Two of the six codes, 75577 and 75580, don’t involve a new scan. Both analyze data from a CCTA that’s already been performed and read.

Code	Service	Contrast	Data source	2026 status	Common error
75571	Coronary calcium scoring	No	Its own noncontrast scan	Established	Assumed covered when the payer treats it as screening
75572	Cardiac structure and morphology	Yes	Its own scan	Established	Used for a coronary-focused study
75573	Congenital heart disease CT	Yes	Its own scan	Established	Used without congenital context
75574	Coronary CTA	Yes	Its own scan	Established	Used for a structural-only study
75577	AI plaque analysis	Not applicable	Existing CCTA data	Category I since January 1, 2026	Billed before the CCTA is interpreted
75580	FFR-CT	Not applicable	Existing CCTA data	Category I since January 1, 2024	Swapped with 75577

CPT 75577 workflow after coronary CTA interpretation

1. The site acquires the CCTA.
2. A physician interprets the CCTA and assigns the CAD-RADS category.
3. The physician orders the plaque analysis when the patient meets the criteria.
4. The software runs, and the physician reviews and signs the plaque report.
5. The claim goes out with 75577, the diagnosis, and the referring NPI.

[Designer: add the five-step workflow diagram here. Alt text: CPT 75577 workflow after coronary CTA interpretation]

Is 75577 an Add-On Code?

CPT 75577 doesn’t read as an add-on code: its published descriptor contains no “list separately in addition to code for primary procedure” language. WPS billing article A59813 describes the service as post-procedure analysis of a previously performed CCTA, and a different entity than the one that ran the scan can bill it.

Treat 75577 as a separate service that depends on a prior CCTA. Some billing sites call it an add-on. Before you label it either way in your charge master or scrubber, check for the add-on symbol in the CPT 2026 codebook and confirm the code’s status in CMS’s add-on code edit files.

Can 75577, 75574, and 75580 Be Billed From the Same CCTA?

Yes. All three can come from one CCTA acquisition when each service is separately ordered, medically necessary, performed, and documented in its own report. Each code still answers to its own coverage policy, so one patient can qualify for plaque analysis and not for FFR-CT, or the reverse.

Stenosis rules show the gap. L39913 excludes plaque analysis when stenosis tops 70% or the CCTA lands at CAD-RADS 4 or 5. FFR-CT policies apply their own stenosis criteria and documentation, including BMI in Palmetto FFR article A58406, and our CPT 75580 FFR-CT billing guide covers those rules.

The 75580 CPT code has been Category I since January 1, 2024, when it replaced 0501T through 0504T. A shared CCTA doesn’t mean shared payment, so bill each line on its own documentation and its own policy.

How Is Plaque Analysis Different From Calcium Scoring?

CPT 75571 is the calcium score CPT code: a noncontrast scan that quantifies calcified plaque only. Plaque analysis under 75577 works from contrast CCTA data, so it also measures noncalcified and low-attenuation plaque, which a calcium score can’t show. Payers often treat standalone calcium scoring as screening, and our 75571 calcium scoring guide explains that coverage.

Coders also confuse 75572 and 75574. CPT 75572 targets cardiac structure and morphology, while the 75574 CPT code targets the coronary arteries. In our CPT 75572 structural cardiac CT guide, you’ll find the documentation that separates them.

Is 75577 Covered by Medicare?

Yes, Medicare covers CPT code 75577 when local coverage criteria are met. Five MACs have final AI-QCT/AI-CPA LCDs, while Novitas and First Coast (FCSO) decide case by case. The CCTA must be completed and interpreted first, the referring NPI must be on the claim, and WPS and Palmetto list R93.1 as the supporting diagnosis.

Medicare Coverage Criteria Under LCD L39913

WPS LCD L39913 covers AI-QCT/AI-CPA as a diagnostic study only when the patient meets all three criteria below. CAD-RADS, used in the second criterion, is the standardized 0 to 5 scale for reporting stenosis findings on a CCTA.

1. The patient has acute or stable chest pain, no known coronary artery disease (CAD), and is eligible for CCTA.
2. The CCTA classifies the patient as intermediate risk, or as CAD-RADS 1, 2, or 3.
3. Cardiac evaluation is negative or inconclusive for acute coronary syndrome (ACS).

Two conditions sit on top of those criteria. The base CCTA has to be completed and interpreted before the analysis runs, with CCTA eligibility judged under LCD L35121, and the software must be FDA cleared or approved. For background on how LCDs work and how MACs apply them, see our provider guide.

When Won’t Medicare Cover AI Coronary Plaque Analysis?

L39913 lists eight situations where the analysis isn’t considered reasonable and necessary. Four relate to the patient’s status, and four relate to the test context.

Patient status exclusions

• Screening, with no signs, symptoms, or disease
• Unstable coronary symptoms
• Within 30 days of a myocardial infarction (MI)
• A contraindication to CCTA

Test context exclusions

• Normal CCTA results (CAD-RADS 0 or no plaque)
• High-grade stenosis above 70%, or CAD-RADS 4 or 5
• Performed together with invasive coronary catheterization
• Disease surveillance

The surveillance exclusion matters for follow-up programs. Repeat scans that track plaque change over time aren’t covered under this LCD, even when the first analysis was.

Which MACs Cover CPT 75577?

Five Medicare Administrative Contractors (MACs) finalized AI-QCT/AI-CPA LCDs, according to ACR’s summary of the final LCDs. The final versions extended coverage to stable chest pain and CAD-RADS 1. Novitas and First Coast have no LCD for this service and review claims case by case.

MAC	Jurisdictions	LCD	Billing article	Status
WPS	J5, J8	L39913	A59813	Final, covered
Palmetto GBA	JJ, JM	L39851	A59721	Final, covered
Noridian	JE	L39881	A59769	Final, covered
Noridian	JF	L39883	A59771	Final, covered
NGS	J6, JK	Final; confirm number in the MCD	Confirm in the MCD	Final, covered
CGS	J15	Final; confirm number in the MCD	Confirm in the MCD	Final, covered
Novitas	JH, JL	None	None	Case by case
First Coast (FCSO)	JN	None	None	Case by case

The rules in Palmetto article A59721 mirror the WPS article. Confirm the patient’s MAC by the state where the service was performed, and pull the current LCD and article versions from the Medicare Coverage Database (MCD) before you build scrubber edits.

Do Medicare Advantage Plans Follow the LCD?

Medicare Advantage plans have to follow traditional Medicare coverage rules, including NCDs and LCDs, under the CY 2024 Medicare Advantage final rule (CMS-4201-F). They can still require prior authorization for 75577, so verify the rules at the member’s plan level before the analysis runs.

Does Medicare Cover Cleerly and Other Branded Plaque Scans?

Medicare covers the service, and the brand doesn’t change the code. Any AI-QCT tool with FDA clearance, used within the LCD criteria, is reported with 75577, whether it’s Cleerly, HeartFlow plaque analysis, Elucid, Caristo, or Circle. Patients asking about a specific brand need the same criteria check.

Verify coverage before the analysis runsMatch the patient’s MAC, the LCD criteria, and the plan’s authorization rules before anyone orders the plaque analysis. Our prior authorization services team builds that check into the scheduling step.

Is CPT Code 75577 Covered by Commercial Insurance?

Commercial coverage for CPT 75577 is in place at several large payers. Aetna, UnitedHealthcare, Cigna, and Humana have published coverage for AI plaque analysis, according to industry reporting, and their criteria usually mirror the Medicare LCD. Many plans also require prior authorization, so coverage gets decided plan by plan.

What Does Aetna’s Policy Say About CPT 75577?

CPT codes come from the AMA, so Aetna doesn’t have its own version of CPT 75577; Aetna decides whether to cover it. Industry reporting says Aetna covers plaque quantification from any FDA cleared tool for patients with acute or stable chest pain, no known CAD, and a current CCTA.

If you’re looking for the Aetna policy on CPT 75577 itself, check Aetna’s clinical policy bulletins for the version in effect on your date of service. Save a copy of that version with the claim file, since policy wording can change between the scan and an appeal.

Are Payers Adding 75577 to Prior Authorization Lists?

Yes. According to BlueCross BlueShield of Tennessee’s notice, BCBST added 75577 to its prior authorization code list effective June 1, 2026. Radiology benefit managers such as eviCore also apply their own imaging guidelines for some plans.

An authorization for the CCTA may not extend to the plaque analysis. Ask whether 75577 needs its own approval, and document the answer with a call reference number in the patient’s account.

Commercial Coverage Verification Checklist

These six steps adapt the process in our prior authorization guide to plaque analysis. Run them for each commercial patient before the analysis is ordered.

1. Confirm the plan and product line, beyond the payer brand.
2. Find the policy number and the version in effect on the date of service.
3. Match the patient’s record to the policy criteria.
4. Check whether 75577 needs authorization separately from the CCTA.
5. Confirm the approved rendering provider and site.
6. Save the reference or authorization number to the file.

Which ICD-10 Code Supports CPT Code 75577?

R93.1, abnormal findings on diagnostic imaging of heart and coronary circulation, is the one ICD-10-CM code listed as supporting medical necessity in the WPS billing article A59813 and Palmetto’s A59721. Listing it doesn’t guarantee payment. The medical record still has to meet the LCD criteria.

Why R93.1 Fits the Plaque Analysis Timeline

Diagnostic tests should report the result when it’s known, and the symptoms that prompted the test when it isn’t, per A59813. Plaque analysis is ordered after the CCTA is read, so the CCTA result (plaque present, CAD-RADS 1 to 3) is a known finding. R93.1 captures that finding.

Chest pain codes that supported the CCTA claim don’t carry over to the plaque analysis line by default. Point each line to its own diagnosis, and check the 75577 line on its own in your scrubber.

Where Chest Pain and CAD Codes Still Fit

Vendor reimbursement guides list chest pain codes (R07.x) and coronary artery disease codes (I25.10, I25.11x) as commonly used. Those codes can support the CCTA, commercial claims, or secondary reporting, but they aren’t on the WPS or Palmetto supporting list for 75577.

Teams sometimes search for a coronary artery disease CPT code, but CAD is a diagnosis coded in ICD-10-CM. CPT 75577 is one of several procedure codes used to evaluate it. Check each claim line’s diagnosis pointer against your MAC’s list before release.

Diagnosis Pointer Checklist

Use these four checks on each 75577 line. Mismatches here usually come back as CO-50 medical necessity denials, and each one turns a quick pre-release edit into an appeal.

1. R93.1 points to the 75577 line wherever the MAC’s article lists it.
2. The CCTA report documents the abnormal finding.
3. The diagnosis matches the CCTA report.
4. Commercial claims follow that payer’s own diagnosis list.

What Documentation Does CPT Code 75577 Require?

WPS article A59813 and Palmetto article A59721 require six records: a history and physical detailed enough to assess pretest CAD probability, symptoms consistent with stable ischemic heart disease, the findings that led to the CCTA, the reason for adding AI analysis, the CCTA report, and the AI-QCT/AI-CPA report.

The Six Required Records

Both MAC articles list the records below. Store them in one place in the chart, since a reviewer who can’t find an item treats it as missing.

1. A history and physical sufficient to assess pretest probability of CAD
2. Symptoms consistent with stable ischemic heart disease
3. The findings that led to the CCTA, with the CCTA completed and interpreted
4. The clinical indication for adding AI-QCT/AI-CPA
5. The CCTA report
6. The AI-QCT/AI-CPA analysis report

The articles require all six. A missing item puts the claim at risk on review, even when the patient met the coverage criteria.

Timing Rules That Decide Coverage

The CCTA has to be completed and interpreted before AI coronary plaque analysis runs. If the analysis is ordered before CCTA results exist and the patient turns out not to qualify, Medicare won’t cover it.

Picture a protocol that sends every CCTA to the plaque software by default. Patients with CAD-RADS 0 or CAD-RADS 4 results get analyzed anyway, and each of those claims becomes a denial your team will see again the following month.

A conditional order fixes this. The physician reads the CCTA, assigns the CAD-RADS category, and orders the analysis only when the patient meets the criteria. Document that order and its timing in the chart.

What the Plaque Analysis Report Should Contain

The MAC articles don’t spell out report content. Based on the LCD and billing article requirements, we recommend these six elements so the report holds up on audit. Treat them as recommendations, separate from the stated requirements above.

• Software name and its FDA clearance
• Plaque volume and composition results
• CAD-RADS category from the CCTA
• The interpreting physician’s own conclusions, beyond pasted software output
• Physician signature and date
• The date of the source CCTA

Referring Provider Name and NPI

A59813 requires the referring or ordering physician’s name and NPI on the 75577 claim because the service is post-procedure analysis. On the CMS-1500, that’s Item 17 and 17b; the 837P uses the referring provider loop (2310A at the claim level).

Missing or invalid entries usually come back as CO-16 with remark code N264 (ordering provider name) or N265 (ordering provider identifier). Our guide to CO-16 missing information denials covers the fix and resubmission steps.

How Much Does CPT 75577 Pay in 2026?

CPT 75577 reimbursement for 2026 is $1,012.05 national for the global service in a physician office for non-qualifying APM participants, or $1,017.10 for qualifying APM participants (QPs). Hospital outpatient payment is $950.50 under APC 1511. Locality and contract terms change the amount you receive.

2026 Medicare Physician Fee Schedule Amounts

Medicare pays CPT code 75577 from the amounts in CMS’s July 2026 PFS national payment file, the CMS PFREV26C payment file, which posts separate versions for QPs and non-QPs. The table shows national amounts as of October 2026.

2026 Medicare PFS national amounts for 75577 (source: CMS PFREV26C, July 2026)

Component	Total RVUs	Non-QP national	QP national
Global (no modifier)	30.30	$1,012.05	$1,017.10
Professional (26)	1.24	$41.42	$41.62
Technical (TC)	29.06	$970.63	$975.47

The work RVU is 0.85. These are national amounts before the geographic practice cost index (GPCI) adjustment, so your locality’s figure will differ. Check the file again each quarter, since CMS posts updated versions during the year.

Why Vendors Quote Different 2026 Rates

CPT 75577 reimbursement figures in circulation include $1,012, $1,021, $1,026, and “over $1,000.” The final rule supports two of them. Global total RVUs of 30.30 times the non-QP conversion factor of $33.4009 equals $1,012.05, and 30.30 times the QP factor of $33.5675 equals $1,017.10, per the CMS 2026 PFS final rule fact sheet.

The $1,021 and $1,026 figures don’t match final 2026 RVUs. They likely came from proposed rule numbers, though we can’t confirm their origin. Attach the year, payment system, and QP status to any rate you quote to a physician, an administrator, or a payer.

Hospital Outpatient Payment Under APC 1511

Hospital outpatient departments receive $950.50 for 75577 in 2026 under APC 1511, a New Technology APC, with status indicator S, so no multiple procedure discounting applies. The 2026 OPPS update was 2.6%, according to ACC’s 2026 OPPS summary.

In this setting, the hospital bills 75577 on the institutional claim (UB-04), and the interpreting physician bills 75577-26 on a CMS-1500. Both lines need the same criteria, documentation, and diagnosis support.

Is CPT 75577 Eligible for NTAP?

No. New Technology Add-on Payments (NTAP) apply to inpatient hospital stays paid under the IPPS. CPT 75577 gets paid through OPPS APC 1511 and the PFS instead. Plaque analysis performed during an inpatient admission follows inpatient payment rules, which you’ll need to verify separately.

Commercial Payment and Underpayment Checks

Commercial payment follows your contract, and a covered claim can still pay below the contracted rate. Medicare patients generally owe the Part B deductible and 20% coinsurance, so base patient estimates on the allowable amount.

Compare each ERA line for 75577 against the expected allowable for that payer and component. Our AR follow-up services team works those variances so underpaid lines don’t age out of the appeal window.

How Do You Bill 75577 With Modifiers 26 and TC?

Bill 75577 without a modifier when one entity performs both the technical analysis and the interpretation. Add modifier 26 when you bill only the physician interpretation and report, and TC when you bill only the technical analysis. CMS publishes separate 2026 amounts for each component.

Billing Scenarios by Setting

Setting decides who bills which component. A practice that owns the CCTA, the software, and the read can bill globally. In our cardiology medical billing work, the riskier cases are the ones where that work is split across entities.

Setting	Who bills what	Claim
Physician office runs the CCTA, owns the software, and reads	Global 75577	CMS-1500, POS 11
Hospital outpatient	Hospital: 75577 on the institutional claim. Physician: 75577-26	UB-04 plus CMS-1500 (POS 22 or 19)
Imaging center runs the analysis; outside physician reads	Center: 75577-TC. Physician: 75577-26	Two professional claims
Cloud vendor processes the data set	Depends on the contract	Verify purchased service, reassignment, and anti-markup rules

Hospital claims add a second layer, since the facility and the physician bill separately for the same study, and our hospital outpatient billing team handles both sides. Ordering the study doesn’t entitle you to the global payment, and billing globally without performing both components creates recoupment risk.

How 75577 Sits Next to CPT 75574 on the Claim

CPT 75574 and 75577 are separate claim lines. The 75574 interpretation isn’t part of 75577, and 75577 is reported once per coronary CTA. Dates of service can differ: if the analysis runs a day after the CCTA read, bill each line with the date that service was performed, following the payer’s rules.

ABN Modifiers When Coverage Is Doubtful

A59813 lays out four modifiers for expected non-coverage. Use them only when the facts fit, because each one changes who’s liable for the bill.

• GA: a signed ABN (CMS-R-131) is on file, and a medical necessity denial is expected
• GZ: the same denial is expected, but no ABN was signed
• GX: a voluntary notice was issued for a service excluded for reasons other than medical necessity
• GY: the service is statutorily excluded, such as screening

Part A claims also need occurrence code 32 and the ABN date. Screening plaque scans requested by patients with no symptoms are the textbook GY case, and your front desk should flag them at scheduling.

Component Billing Mistakes to Catch Before Release

Check for these four errors before any 75577 claim leaves your system. Our modifier 26 billing guide covers the professional component rules in more depth.

1. Global and 26 billed by two entities for the same study
2. TC billed by an entity that didn’t run the software
3. Wrong place of service on the professional read
4. Interpreting physician’s name missing from the report

Does CPT Code 75577 Need Prior Authorization?

Original Medicare doesn’t require prior authorization for 75577. Many commercial and Medicare Advantage plans do, and some have added it to their lists: BCBST added 75577 effective June 1, 2026. An authorization for the CCTA alone often doesn’t cover the plaque analysis.

The Sequencing Problem Unique to Plaque Analysis

Plaque analysis creates a timing conflict. Medical necessity is only known after the CCTA read, but authorization is usually requested before the scan. If the analysis runs without approval, you’re facing CO-197 authorization denials, and retroactive approval isn’t guaranteed.

Two fixes work, depending on the payer. Request 75577 with the CCTA as a conditional service where the payer allows it. Otherwise, confirm the payer’s same day or retroactive window before running the software, and don’t assume a retroactive authorization will be available.

What Changed in 2026 Decision Timelines

Under the CMS-0057-F final rule, impacted payers must decide expedited prior authorization requests within 72 hours and standard requests within seven calendar days, starting January 1, 2026. Impacted payers include Medicare Advantage, Medicaid, CHIP, and Marketplace plans, and they have to give a specific reason for any denial.

The rule sets decision speed only. Each plan still decides whether 75577 needs authorization, and that answer can differ between a member’s commercial and Medicare Advantage products.

Five Authorization Checks for 75577

Before the software runs, confirm these five items. Our eligibility and prior authorization team runs the same checks at scheduling, so the authorization matches the claim.

1. The plan and product line
2. A separate listing for 75577, apart from 75574
3. The approved rendering provider and site
4. A date range that covers the analysis date
5. The reference number saved to the claim

Why Do 75577 Claims Get Denied, and How Do You Fix Them?

Most CPT code 75577 denials trace back to six issues: a T-code on a 2026 claim, a missing referring NPI, a diagnosis that isn’t on the MAC’s list, missing authorization, an analysis run outside LCD criteria, or a second plaque analysis billed on the same CCTA.

75577 Denial Map

Use this map as a starting point. Response codes vary by payer, so read the remark code on the remittance before you act.

What happened	Typical response	First fix
0623T through 0626T on a 2026 date of service	CO-181, CO-16 with M51, or a front-end rejection	Correct to 75577 and resubmit
Referring name or NPI missing	CO-16 with N264 or N265	Add Item 17 and 17b, then resubmit
Diagnosis not on the MAC list	CO-50 or CO-11	Check R93.1 against the report, then correct or appeal
No authorization on file	CO-197	Request retroactive authorization if allowed; otherwise appeal
Authorization number missing from the claim	CO-16	Add the number and send a corrected claim
CAD-RADS 4 or 5, surveillance, or done with catheterization	CO-50	Usually not appealable under L39913
Two analyses billed for one CCTA	CO-18 or a frequency edit	Void the duplicate
Component conflict between entities	CO-4	Fix the modifiers

Modifier conflicts between the facility, the imaging center, and the reading physician often surface as CO-4. Our guide to CO-4 modifier denials explains how to trace which entity billed the wrong component.

Corrected Claim or Appeal?

On a 75577 CPT claim, data errors call for a correction: a wrong NPI, a T-code, a modifier, or a missing authorization number. Depending on the payer, that means a new claim after a rejection, a replacement claim with frequency code 7, or a reopening.

An appeal fits a correct claim the payer misjudged, such as a patient who met each criterion and has a complete record. Changing the diagnosis or clinical facts to get paid creates a compliance problem larger than the original denial, so keep corrections to data errors.

Turn Repeat Denials Into Front-End Rules

Track 75577 denials by payer, CARC, root cause, and dollar value. Two denials with the same root cause mean the workflow needs a change: a scrubber edit, an order set update, or a new report template.

That’s the work our denial management services team does each week for cardiology groups. We trace the pattern, fix the rule upstream, and recover what’s still appealable.

Your 2026 Implementation Checklist for 75577

Most 2026 problems with 75577 start in systems nobody updated: charge masters, order sets, authorization templates, and report templates that still assume 0623T through 0626T or send every CCTA to the software by default. Work through both lists below before your next plaque analysis claim.

Systems to update

1. Charge master: retire the T-codes and add 75577 with global, 26, and TC lines
2. Order sets: make the analysis a conditional order after the CCTA read
3. Authorization templates: list 75577 separately from 75574
4. Report template: add the recommended elements from the report section above
5. Scrubber edits: R93.1 pointer, referring NPI, and once per CCTA

People and policies to check

• Credentialing of interpreting physicians under the LCD
• FDA clearance documentation for your software
• A payer policy matrix by MAC and commercial plan
• Staff training on the conditional order rule

How One O Seven RCM Handles AI Plaque Analysis Billing

AI coronary plaque analysis touches four teams: scheduling, reading, coding, and AR. One O Seven RCM, a full-service revenue cycle management company in Fulshear, Texas, connects those steps so the order, the report, the authorization, and the claim describe the same service. Our coders check CPT code 75577 claims against the LCD before release.

Full-service medical billing costs 3% of collections received from payers, with no upfront fee and no setup charge. That covers eligibility, prior authorization, coding validation, claim submission, payment posting, denials, and AR follow-up. Provider credentialing is $107 per payer.

These are One O Seven RCM’s service fees. They’re separate from Medicare or payer reimbursement for 75577 or any other code.

Plaque analysis claims stalling?If your plaque analysis claims stall between the read and the remittance, we can review the workflow with you. See how our full-service RCM process covers each step from order to payment.

CPT Code 75577 FAQs

What is CPT code 75577?

CPT 75577 is the Category I code, effective January 1, 2026, for AI quantification and characterization of coronary plaque from an existing CCTA data set, with a physician’s interpretation and report. It replaced Category III codes 0623T through 0626T and is reported once per coronary CTA, separate from the 75574 interpretation.

Is CPT code 75577 covered by insurance?

Yes, when payer criteria are met. Medicare covers it under final LCDs from five MACs, while Novitas and First Coast decide case by case. Aetna, UnitedHealthcare, Cigna, and Humana have published coverage, according to industry reporting, and many commercial plans require prior authorization. Check the plan’s policy for the date of service.

Is 75577 an add-on code?

The published descriptor has no add-on language, so treat 75577 as a separate service. WPS describes it as post-procedure analysis of a previously performed CCTA, reported once per CTA, and a different entity can bill it. Confirm the add-on symbol in your CPT 2026 codebook before you set charge master rules.

What is the OPPS rate for CPT 75577?

The 2026 OPPS rate for CPT 75577 is $950.50 under APC 1511, with status indicator S, so no multiple procedure discount applies. Hospitals bill that amount on the institutional claim. Interpreting physicians bill 75577-26 separately under the physician fee schedule, at $41.42 national for non-QPs.

Is CPT 75577 eligible for NTAP?

No. New Technology Add-on Payments apply to inpatient stays under the IPPS. CPT 75577 is paid through OPPS APC 1511 in the hospital outpatient setting and through the physician fee schedule for professional and office claims. If the analysis happens during an inpatient admission, inpatient payment rules apply.

What ICD-10 code supports 75577 claims?

R93.1, abnormal findings on diagnostic imaging of heart and coronary circulation, is the only supporting diagnosis listed in the WPS and Palmetto billing articles. Listing the code doesn’t guarantee payment. The record still needs the CCTA findings, the clinical indication, and the other documentation the articles require.

Can 75577 and 75580 be billed from the same CCTA?

Yes, when each service is ordered, meets its own coverage policy, and has its own report. CPT 75580 (FFR-CT) and 75577 (plaque analysis) both use existing CCTA data, but their stenosis criteria and documentation rules differ, so one patient can qualify for one and not the other.

What happens if we bill 0623T in 2026?

That claim won’t process. The AMA deleted 0623T through 0626T effective January 1, 2026, and the MACs updated their billing articles to list 75577 instead. Correct the line to 75577, check that the authorization matches the new code, and resubmit.

Before You Release a 75577 Claim

Run these two checklists on each 75577 claim. The first applies before the software runs, and the second applies before the claim leaves your system.

Before the analysis runs

1. The CCTA is completed and interpreted.
2. The patient meets the LCD or payer criteria.
3. Authorization is confirmed where required.
4. The software has FDA clearance.

Before the claim goes out

1. 75577 is on the claim, with no T-code
2. The component is correct: global, 26, or TC
3. The referring name and NPI are on the claim
4. R93.1 points to the line where the MAC lists it
5. A signed plaque analysis report is on file
6. One analysis is billed per CCTA

If you’d rather have these checks built into your workflow, our cardiology billing team can take over plaque analysis claims from charge entry through payment.