ASNC Fighting Back Against Proposed Reimbursement Cuts for Amyloid Imaging

Nuclear cardiologists are protesting the US Centers for Medicare & Medicaid Services potential 57% reimbursement cuts for pyrophosphate (PYP)/amyloid imaging, mere days before the comment period on the 2026 Hospital Outpatient Prospective Payment System (HOPPS) proposed rule closes.

The drastically reduced payments for this imaging, which is pivotal to diagnosing cardiac amyloidosis, would stunt the burgeoning ability of physicians to treat patients with newly approved drugs for transthyretin amyloid cardiomyopathy (ATTR-CM), according to American Society of Nuclear Cardiology’s (ASNC). In the United States, these pricy options include acoramidis (Attruby, BridgeBio), tafamidis (Vyndamax and Vyndaqel; Pfizer), and vutrisiran (Amvuttra; Alnylam).

While PYP/amyloid imaging itself does not require expensive equipment—it can be performed in any institution that offers stress testing for CAD with a SPECT camera—trained imagers are needed to offer it and be on the lookout for patients who might benefit.

“The field is nascent [and] it’s growing in the right direction,” Saurabh Malthotra, MD (John H. Stroger, Jr. Hospital of Cook County, Chicago, IL), a member of the ASNC Health Policy Committee, told TCTMD. If the cuts go through, “it’s going to jeopardize the interest in the field” as well as the recent recognition that the disease “is more prevalent than we thought it used to be,” he added.

Moreover, “my concern, having worked in a city hospital [treating] underserved populations, is that folks who really need to get the diagnosis, which is the underserved African American population with hereditary amyloid,” are going to go undiagnosed, Malthotra stressed. “Healthcare disparities will increase.”

‘Devastating’ Cuts

While the HOPPS proposed rule was released in July, ASNC reviewers only recently discovered in addendum files that the CPT code 78803, which includes a wide range of radiopharmaceutical imaging, would be reassigned to a new ambulatory payment classification (APC) in 2026. The proposed change would lower the payment from $1,305.48 to $558.70.

The organization sent an email to its membership this week calling for written statements to CMS before the comment window closes on Monday September 15 and the final rule is cemented.

“Had it been explicitly stated in the proposed rule, I think we would’ve acted on it earlier,” Prem Soman, MD, PhD (University of Pittsburgh Medical Center, PA), another ASNC Health Policy Committee member, told TCTMD. Soman, who delivered the keynote lecture at the society’s annual meeting on the rapid transformation of cardiac amyloid care over the past decade, added that these cuts would be “devastating” for the field.

As recently as 8 years ago, amyloidosis was more of a “diagnostic curiosity” for cardiologists, who didn’t have many options for diagnosing or treating it. “We thought it was quite rare,” Soman said. “All of that has changed.  Because of PYP, now we can make a confirmed diagnosis noninvasively. I run an amyloidosis center and nuclear cardiology, and [for] around 85% of our patients now that are referred for a suspected diagnosis of amyloid . . . we do this without a biopsy.”

The bottom line is “there’s a lot more amyloidosis than we ever imagined,” he said, and today there are life-changing therapies. “All of this, in many ways, was catalyzed by PYP. Even recruiting patients into clinical trials became so much easier. . . . So a 50% cut coming all of a sudden is really going to be detrimental to patient care more than anything else.”

Time for a New CPT Code?

The ASNC suggests that the proposed APC reassignment is related to a new CMS policy mandating that isotopes that cost more than $630 be paid for separately from the imaging itself.

“Because the new policy took effect this year, it is important that physicians and hospitals have time to properly account for resources and inputs associated with 78803,” the organization writes in a template letter available to members. “As such, CMS should collect several years of geometric mean data before making a decision whether to reassign 78803 to another APC.”

Malthotra argued in favor of PYP imaging receiving its own CPT code to protect it and separate it out from other tests that might be more costly.

“If you did a brain scan and you got an expensive isotope and they slash the cost of the brain scan because they’re paying for the isotope cost separately, I can see that making sense in that particular scenario when the isotope is super expensive,” he said. “But not in this scenario. In this scenario, the isotope is not that expensive, and yet they’re still cutting it by the same amount.”

Soman agreed, but said their short-term goal is to make sure the proposed rule is not finalized before more thoughtful discussion can be held. “For the moment, we have to pause and give people time to process this and propose alternatives and so on and so forth. The immediate ask is to not rush this through.”

“This is a growing field and if you put the kibosh on it up front, then there’s no way that folks who really need to be doing this across the country will have any more any interest to do so,” Malthotra concluded.