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CAC Reimbursement for Routine Chest CT Scans

The new Medicare code G0680 brings reimbursement for coronary artery calcium (CAC). Health systems can transform routine imaging into a proactive cardiovascular screening tool. Use this customizable ROI calculator to demonstrate the potential financial impact of the new reimbursement code for AI-powered CAC on ordinary ungated, non-contrast chest CT exams.

New Medicare Code G0680 Creates a New Pathway to Generate Revenue for Coronary Artery Calcification (CAC)

Adjust the CT scan volume and other variables to see how ClearRead CT could bring value to your organization. Also included in this ROI calculator is a financial model for a patient cash pay model, a strategy that many healthcare organizations already deploy for gated CAC exams. As CAC reimbursement is limited to the Hospital Outpatient Prospective Payment System (OPPS), other locations in your network may benefit from this alternative model for self-pay.

Learn more about the new Medicare code G0680 or contact us to schedule a ClearRead CT demo.

Riverain ClearRead CT — CAC G0680 Reimbursement Model (Standalone)
Sliders are editable and all outputs recalculate instantly. Use Print/Save to export a PDF.
RIVERAIN TECHNOLOGIES
riveraintech.com
CLEARREAD CT
Coronary Artery
Calcification
G0680 Reimbursement ROI
Return on Investment Analysis
Five-Year Business Case Projection — Interactive
G0680 — CMS Direct Reimbursement (OPPS)
New CMS billing code for hospital outpatient CAC scoring
Patient Cash Pay Program
Applies to non-G0680-reimbursed scans only
Default: 10,000 annual non-contrast chest CTs · G0680 $15.50/scan · 80% eligible · 85% approval
Cash pay defaults: 25% acceptance · $50 per patient
5-Year Return on Investment Summary
Total 5-Year Return
$0
Total Investment
$0
Net ROI
$0
Return Multiple
0.0x
Revenue by Stream (5-Year)
G0680 Direct Reimbursement$0
Patient Cash Pay$0
Riverain Technologies · ClearRead CT · CAC Moduleriveraintech.com
RIVERAIN TECHNOLOGIES
ClearRead CT · Cardiothoracic AI Suite
CAC ROI — G0680 Reimbursement (Standalone)
Non-Contrast Volume · G0680 Variables · Cash Pay Add-On
Volume and Program Inputs
Non-Contrast Chest CTs / Year
CPT 71250, 71271 · addressable volume for G0680 and cash pay streams
10,000
Annual non-contrast chest CTs 10,000
10100,000
SaaS cost per scan $6.00
$1$10
Cash pay acceptance rate 25%
0%100%
Cash pay amount per patient $50
$0$250
G0680 — CMS Direct Reimbursement (OPPS) · New CMS Billing Code
CMS OPPS code for hospital outpatient CAC scoring. Scans reimbursed via G0680 are excluded from cash pay to prevent double-counting.
ACTIVE
Medicare payment rate (per scan)
$15.50
$5.00$50.00
Eligible scans for G0680 billing
80%
10%100%
Coverage approval rate (percent of submitted)
85%
50%100%
Eligible Scans / Year
0
Approved Claims / Year
0
Annual G0680 Revenue
$0
5-Year G0680 Revenue
$0
Patient Cash Pay Add-On (excludes G0680-approved scans)
Offer CAC scoring as a self-pay add-on for patients not reimbursed via G0680. Model assumes cash pay is offered only to scans not billed or paid under G0680.
Cash Pay Pool (Non-Contrast CTs minus G0680 claims)
0
eligible CTs for self-pay offering
Annual Cash Pay Revenue
$0
pool × acceptance × price
Based on national Medicare averages and published clinical literature.CAC G0680 Reimbursement Model · riveraintech.com

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