CPT 75580 FFR‑CT Reimbursement & Policy | OpenPayer

Summary & Overview

CPT 75580: FFR-CT from Coronary CT Angiography via Augmentative Software

CPT code 75580 designates use of augmentative software to analyze an existing coronary computed tomography angiography (CCTA) data set and estimate coronary fractional flow reserve (FFR-CT), with interpretation and reporting by a qualified clinician. This code captures a growing class of noninvasive physiologic assessments derived from advanced image post-processing rather than additional image acquisition. Nationally, the code matters because it defines billing and clinical documentation for an emerging diagnostic tool that can influence downstream care decisions for patients with suspected coronary artery disease.

Key payers included in the discussion are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will learn how the code is defined clinically, where the service is typically delivered, and which payers are relevant to coverage and billing discussions. The publication provides benchmarks and policy context where available, explains clinical use cases for FFR-CT as an adjunct to CCTA, and summarizes reporting expectations tied to CPT code 75580.

Data not available in the input: specific coverage policies, reimbursement rates, associated taxonomies, and ICD-10 diagnosis mappings.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare75580cptffr-ctcctacardiac-imagingimage-post-processingnoninvasive-physiology

Billing Code Overview

CPT code 75580 describes an augmentative software analysis that processes data from a separate coronary computed tomography angiography (CCTA) study to estimate coronary fractional flow reserve (FFR-CT). A physician or other qualified healthcare professional provides the final interpretation and report.

Service type: Imaging-derived physiologic assessment using post-processing software applied to CCTA source data.

Typical site of service: Outpatient imaging centers or hospital outpatient departments where CCTA studies are performed and advanced image post-processing is available.

Clinical & Coding Specifications

Clinical Context

A typical patient is a 58-year-old with stable exertional angina and intermediate coronary artery disease risk who previously underwent a coronary computed tomography angiography (CCTA) that demonstrated 40–70% stenosis in one or more coronary segments. The clinician orders augmentative software analysis to derive noninvasive fractional flow reserve from the existing CCTA dataset. A cardiovascular imaging technologist or PACS specialist exports the deidentified CCTA DICOM images to the FDA-cleared software. The software performs computational fluid dynamics and lesion-specific FFRCT estimation. A board-certified cardiologist or cardiovascular radiologist reviews the software output, integrates the FFRCT values with the anatomic CCTA findings, documents a formal interpretation, and issues an electronic report that supports clinical decision-making for medical therapy versus invasive coronary angiography.

Common workflow steps:

Order and verify indication for 75580 based on prior CCTA demonstrating intermediate stenosis.
Retrieve and prepare CCTA DICOM images for transfer to the FFRCT software vendor.
Run the augmentative software analysis and receive quantitative FFRCT values by coronary segment.
Interpreting physician reviews images and FFRCT results, produces an interpretation and final report.
Bill 75580 for the software-based analysis with the physician interpretation; append appropriate modifier(s) per payer and service circumstances.

Coding Specifications

CPT 75573: Cardiac CT for Congenital Heart Evaluation

CPT-75565-CARDIAC-MRI-VELOCITY-FLOW-MAPPING

CPT 75565: Cardiac MRI with Velocity Flow Mapping

CPT-75557-CARDIAC-MRI-NON-CONTRAST-STRUCTURE-AND-FUNCTION

CPT 75557: Cardiac MRI for Structure and Function, No Contrast

CPT-75561-CARDIAC-MRI-WITH-AND-WITHOUT-CONTRAST

CPT 75561: Cardiac MRI Without and With Contrast

CPT-75563-CARDIAC-MRI-STRESS-REST-WITH-AND-WITHOUT-CONTRAST

CPT 75563: Cardiac MRI Stress and Rest with and without Contrast

CPT-75572-CARDIAC-CT-3D-POST-PROCESSING-FUNCTIONAL-ASSESSMENT

CPT 75572: Cardiac CT with 3D Post-Processing and Functional Assessment

CPT-75571-CORONARY-CALCIUM-SCORING-CT-NON-CONTRAST

CPT 75571: Non-Contrast CT Coronary Calcium Scoring

CPT-75574-CARDIAC-CT-WITH-CONTRAST-CORONARY-EVALUATION

CPT 75574: Cardiac CT With Contrast for Coronary Evaluation

CPT-75577-CORONARY-CTA-PLAQUE-QUANTIFICATION-POST-PROCESSING

CPT 75577: Coronary CTA Plaque Quantification and Post-Processing

CPT-75559-CARDIAC-MRI-STRESS-NON-CONTRAST

CPT 75559: Cardiac MRI with Stress, Non-Contrast

Modifier	Description	When to Use
`26`	Professional component	Use when only the physician interpretation/report is billed separate from the technical image processing fee.
`TC`	Technical component	Use when billing only the technical portion of service (image processing) by the facility or vendor.
`59`	Distinct procedural service	Use when documentation supports that the FFRCT analysis is distinct from another diagnostic procedure performed the same day.
`52`	Reduced services	Use when the analysis is partially completed or limited and full service is not furnished.
`53`	Discontinued procedure	Use when the analysis was started but terminated due to clinical or technical reasons.
`91`	Repeat clinical diagnostic laboratory test	Use if repeat analysis is performed on the same day with separate clinical indications (some payers accept for repeat processing).
`62`	Two surgeons	Use when two qualified physicians from different specialties jointly interpret and report and payer policy allows.
`22`	Increased procedural services	Use when additional work or complexity beyond typical is documented for interpretation.
`80`	Assistant surgeon	Rarely used; vendor-assisted or facility-specific billing arrangements may require.
`QX`	Qualified nonphysician practitioner with modifier `QK`	Use when a qualified nonphysician practitioner provides the interpretation under allowable payer rules in combination with `QK`.
`QY`	Qualified nonphysician practitioner	Use when a qualified nonphysician practitioner performs interpretation and payer allows independent billing.
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist services in lieu of physician	Use per payer policy when APP interprets under scope of practice and payer allows.
`62`	Multiple surgeons (duplicate entry avoided)	See above — included only once in selection.

Taxonomy Code	Specialty	Notes
`207RP2000X`	Cardiovascular Disease (Cardiology)	Interpreting physicians commonly are noninvasive cardiologists.
`207T00000X`	Radiology	Cardiothoracic or diagnostic radiologists perform CCTA interpretation and FFRCT correlation.
`2084P0800X`	Vascular & Interventional Cardiology	Interventional cardiologists use FFRCT results to guide invasive angiography decisions.
`367A00000X`	Nuclear Cardiology	Cardiac imaging specialists involved in multimodality interpretation in some centers.
`363LE0700X`	Echocardiography	Cardiac imaging physicians who integrate multimodality data in comprehensive reports.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I25.10`	Atherosclerotic heart disease of native coronary artery without angina pectoris	Chronic coronary disease often evaluated with CCTA and FFRCT to assess lesion significance.
`I25.110`	Atherosclerotic heart disease of native coronary artery with unstable angina	FFRCT may assist in evaluating ischemic burden in patients with angina symptoms.
`I20.9`	Angina pectoris, unspecified	Symptom-based indication for noninvasive ischemia assessment with CCTA and FFRCT.
`I25.700`	Atherosclerosis of coronary artery bypass graft(s), unspecified, with angina pectoris	FFRCT can help evaluate graft or native vessel lesion hemodynamic significance when CCTA data are available.
`R07.9`	Chest pain, unspecified	Common presenting symptom prompting CCTA and subsequent FFRCT analysis to stratify coronary disease.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`75574`	Coronary computed tomography angiography, with contrast, including image post-processing when performed; single study without cardiac CTA flow analysis	This is the anatomic CCTA acquisition typically performed before FFRCT analysis; `75580` analyzes data derived from a prior CCTA such as `75574`.
`93799`	Unlisted cardiovascular service or procedure	May be used for ancillary or nonstandard processing services if vendor-specific technical services are not separately billable; not routine for FFRCT.
`71046`	Radiologic examination, chest, two views, frontal and lateral	May be performed as adjunct baseline imaging but is not a substitute for CCTA when planning FFRCT.
`93000`	Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report	Often performed as part of pre-test assessment or outpatient evaluation prior to CCTA and FFRCT.
`0074U`	Computed tomography, heart, noninvasive FFRCT analysis (proprietary/Category III when applicable)	Some workflows include proprietary or category-level codes for vendor-specific FFRCT processing; relates directly as an alternative or adjunct to `75580`.

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