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What You Should Know:
– United Healthcare has updated its cardiac imaging guidelines to align with recommendations from radiology benefit manager EviCore, announcing new coverage for coronary computed tomography angiography (CTA) plaque quantification.
– The new coverage, effective October 1, 2025, specifically includes Elucid’s PlaqueIQ
technology. This is a major step forward for Elucid, a company that uses AI to give physicians a more precise view of atherosclerosis.
PlaqueIQ: A Non-Invasive Tool for Personalized Care
PlaqueIQ is the first and only FDA-cleared, non-invasive plaque analysis based on objective histology. The software provides automated quantification and classification of plaque morphology. It is uniquely capable of identifying and quantifying lipid-rich necrotic core, a type of plaque strongly linked with cardiovascular risk. This technology is designed to help physicians move beyond population-based risk assessments to prioritize and personalize treatment based on a patient’s actual coronary artery disease. This allows for the development of personalized care pathways, which can help in evaluating the risk of future cardiac events such as heart attack and stroke.
Expanding Access and Complementary Policy Changes
This new coverage from United Healthcare is part of a series of policy changes aimed at expanding access to advanced cardiac imaging. A new CMS rule that went into effect on January 1, 2025, doubled the amount paid to hospitals and outpatient clinics for cardiac CT scans from $175 to $357.13. This has allowed more hospitals, particularly those in non-urban areas, to offer the service, thereby reducing disparities in care. Additionally, in late 2024, five of the seven Medicare Administrative Contractors (MACs) extended coverage of Elucid’s PlaqueIQ, making it available to over 70% of eligible Medicare patients.
A newly assigned Category I code for coronary plaque analysis will go into effect on January 1, 2026. This new code complements the recent coverage decisions by United Healthcare and EviCore, which will allow for expanded patient access and personalized treatment for patients with coronary artery disease (CAD).
Kelly Huang, PhD, CEO of Elucid, stated that United Healthcare’s updated guidelines “further underscore the need for better tools to help clinicians get ahead of heart attack and stroke”. She believes that PlaqueIQ, with its foundation in CT Virtual Histology, is “poised to make a meaningful difference towards this goal”.
