Part 3 of 5 in Circle's Coronary Plaque series. Also read:
Part 1 — How Advanced Plaque Analysis Changes the Clinical Calculus

Part 2 — The IT Infrastructure Behind CCTA Plaque Analysis

The cardiology service line is under familiar financial pressure: rising volumes, tighter margins, growing competition from outpatient and independent imaging centers, and a capital environment that demands every major investment justify itself with a clear return.

Against that backdrop, coronary plaque analysis has emerged as a meaningful financial opportunity — one with a growing reimbursement pathway, expanding referral demand, and the kind of clinical differentiation that drives patient retention. But the financial case only materializes if the program is set up to deliver the service efficiently and at scale.

This is not an investment in a research capability. It is an investment in a billable, guideline-supported clinical service with a documented and growing payer footprint.

The Reimbursement Landscape

CCTA itself has strong and stable reimbursement. CPT 75574 — CT angiography of the coronary arteries — carries national Medicare allowable rates that make CCTA one of the more financially productive non-invasive cardiac studies. Volume growth has been consistent: CCTA utilization has grown significantly since the 2021 ACC/AHA Chest Pain Guidelines elevated it to a Class I recommendation, and that growth is accelerating as programs adopt CCTA as the primary pathway for chest pain evaluation.

Advanced plaque analysis adds incremental clinical value to each CCTA study — and reimbursement pathways are expanding to reflect that. As of January 1, 2026, AI-enabled coronary plaque analysis is reported through a single Category I code, CPT 75577, replacing the deleted Category III codes (0623T–0626T) and placing plaque analysis on the national Medicare fee schedule. The American College of Radiology and Society of Cardiovascular Computed Tomography provide current guidance on coding and payer policy for CCTA programs.

For programs still relying primarily on calcium scoring as their coronary risk tool, the shift to full plaque characterization represents both an upgrade in clinical capability and a meaningful upgrade in the per-study revenue profile.

The New Revenue Service Opportunity

The financial case is not only about per-study billing. It is also about building a competitive, differentiated service that generates referral volume.

Preventive cardiology is one of the fastest-growing areas of cardiovascular practice. The combination of growing awareness of cardiovascular risk, expanding use of PCSK9 inhibitors and aggressive lipid-lowering therapy, and increasing emphasis on coronary risk stratification is driving a new category of patient: the motivated, health-conscious individual who wants to know the true state of their coronary arteries — not just their cholesterol number.

This patient refers themselves, or comes through primary care and preventive medicine channels that are actively looking for programs capable of delivering comprehensive coronary risk assessment. Calcium scoring is table stakes. Advanced plaque characterization — total plaque burden, high-risk plaque feature assessment, progression tracking over time — is the differentiator that wins that referral.

Programs that can offer a complete coronary plaque evaluation as a defined, bookable service are positioned to capture a referral stream that didn't previously exist in their market. The MESA study and related population-based cardiovascular risk research have created a well-informed patient population. Meeting that demand with advanced plaque analysis is a new revenue service — and one with favorable reimbursement and minimal marginal cost once the platform is in place.

Where the Cost Equation Goes Wrong

Many organizations underestimate the total cost of running a fragmented cardiovascular imaging environment. The budget line for software licensing is visible. The hidden costs are not:

Staff time on manual workflows. When plaque analysis requires manual quantification in a separate tool, radiologists and cardiologists spend 20-45 additional minutes per study. At their compensation rates, that time has a real cost — and it constrains the number of studies the program can turn around each day.

Report turnaround time drag. Studies that take longer to report create a backlog. Backlogs reduce throughput. Reduced throughput means the program cannot capture the full referral volume it could otherwise support.

Multiple licensing fees. A standalone plaque analysis tool carries its own licensing cost — separate from the main post-processing platform, PACS, and reporting tools already in the budget. For many programs, the cumulative licensing cost across a fragmented imaging software stack is significantly higher than it would be with a unified platform.

Integration and maintenance overhead. As discussed in Part 2 of this series) — the IT costs of maintaining separate integrations, managing multiple vendor relationships, and handling independent patching cycles represent real operational expenditure that rarely appears in the initial software evaluation.

Building the Financial Model

For CFOs and finance leadership evaluating investment in advanced CCTA capabilities, the model typically includes four components:

1. Revenue capture. How many CCTA studies does the program currently perform annually? What is the incremental billing opportunity from adding quantitative plaque analysis to each study? What is the addressable preventive cardiology referral market that plaque-capable programs can access?
2. Cost consolidation. What does the current imaging software stack cost in aggregate, including licensing, maintenance, and IT overhead? What is the all-in cost of a unified platform that consolidates those capabilities?
3. Throughput improvement. If AI-assisted plaque analysis reduces per-study reporting time, what is the resulting increase in daily and annual throughput capacity? What is the revenue value of that additional capacity?
4. Referral retention. What is the cost of a lost referral in a competitive cardiac imaging market? How does clinical differentiation — the ability to offer something a competing program cannot — factor into patient and referral source retention?

The organizations that find the most compelling ROI are typically those running three or more separate cardiovascular imaging tools.

Consolidating onto a single platform while adding plaque analysis capability frequently results in a total cost that is lower than the fragmented stack it replaces — while delivering a material clinical and revenue upgrade.

The Cost of Waiting

The reimbursement expansion for advanced coronary plaque analysis is ongoing. Programs that build this capability now establish the workflow, the referral relationships, and the reporting infrastructure that allow them to scale as utilization grows.

Programs that defer are building those capabilities later — at higher referral competition, with less time to optimize throughput before the market normalizes.

The preventive cardiology patient is already there. The question is whether they are referred to your program or to one that can tell them more.

Calculate a financial impact analysis for your CCTA program →

Stay tuned for more on Advanced Plaque Analysis from the perspective imaging lab directors and department heads.