Heartflow Plaque Analysis Now Covered by Aetna Insurance Plans Nationwide and for the Majority of Insured Lives in the U.S.

Rhea-AI Summary

Heartflow (Nasdaq: HTFL) announced that Aetna now covers Heartflow Plaque Analysis across Commercial, Medicare Advantage, and Aetna Better Health Medicaid plans, effective December 23, 2025 for patients with acute or stable chest pain and 1–69% coronary stenosis on coronary CTA. This makes Aetna the fourth major national payer to align coverage with EviCore and expands access to the majority of insured lives in the U.S.

Reimbursement moved forward with new Category I CPT code 75577 effective January 1, 2026, establishing 0.85 RVUs for physicians and a combined total of 4.00 RVUs. The release cites real-world evidence including the DECIDE Registry (>50% management change) and FDA clearance with 95% agreement to IVUS.

Positive

• Aetna national coverage effective Dec 23, 2025
• Majority of insured lives in U.S. covered
• New Category I CPT 75577 effective Jan 1, 2026
• 0.85 RVUs physician valuation; 4.00 RVUs total
• DECIDE Registry: >50% medical management change
• FDA-cleared with 95% agreement to IVUS

Negative

• Coverage limited to patients with 1–69% stenosis on coronary CTA
• Aetna policy effective date (Dec 23, 2025) may delay immediate access for some patients

Argus Jan 6 session

+2.50% close to close Open Argus

Details

News Market Reaction – HTFL

In the Jan 6 session, HTFL gained 2.50%, reflecting a moderate positive market reaction.

Data tracked by StockTitan Argus on the day of publication.

Market Context

This announcement highlights nationwide Aetna coverage for Heartflow Plaque Analysis and a new Categ...

Analysis

This announcement highlights nationwide Aetna coverage for Heartflow Plaque Analysis and a new Category I CPT code 75577 with 0.85 and 4.00 RVUs established, reinforcing reimbursement clarity. It builds on DECIDE registry data showing management changes in more than 50% of patients and 95% agreement with IVUS. Investors may watch payer adoption breadth, procedure volumes under the new code, and future clinical data readouts as key markers of commercial traction.

Key Figures

CPT code: 75577 RVUs per analysis: 0.85 RVUs Total RVUs: 4.00 RVUs +5 more

CPT code

75577

New Category I CPT code for Heartflow Plaque Analysis, effective Jan 1, 2026

RVUs per analysis

0.85 RVUs

Relative value units assigned to CPT 75577

Total RVUs

4.00 RVUs

Combined RVUs for physicians performing Heartflow Plaque Analysis

Stenosis range

1–69% stenosis

Eligible Aetna patients with narrowing on coronary CTA

Management change rate

More than 50% of patients

DECIDE registry, change in medical management with Plaque Analysis vs CCTA alone

IVUS agreement

95% agreement

Heartflow Plaque Analysis vs IVUS using blinded core lab adjudication

Aetna coverage effective

December 23, 2025

Effective date for updated Aetna policy covering Plaque Analysis

CPT effective date

January 1, 2026

Start date for Category I CPT code 75577

Historical Context

5 past events · Latest: Dec 18

5 events

1. Dec 18

   Guideline endorsement

   24h Move

   +6.5%

   ACC/AHA scientific statements backing quantitative plaque assessment and Heartflow pathway.

2. Dec 11

   Clinical/economic data

   24h Move

   +1.0%

   Large FFRCT analyses showing outcome prediction and health‑economic savings in >90,000 patients.

3. Nov 19

   Conference participation

   24h Move

   -0.3%

   Announcement of participation in Piper Sandler healthcare conference and webcast availability.

4. Nov 12

   Earnings results

   24h Move

   +4.6%

   Q3 2025 revenue growth and IPO-funded balance sheet, plus commercial coverage highlights.

5. Nov 03

   Clinical data preview

   24h Move

   -8.4%

   Planned late‑breaking AI-driven plaque analysis data presentations at AHA 2025.

24h Move is the share-price change in the day after each event; other market factors may also have contributed.

Key Terms

coronary artery disease, coronary CTA, current procedural terminology, cpt, +4 more

8 terms

coronary artery disease medical

"the leader in AI technology for coronary artery disease (CAD), today announced"

Coronary artery disease is a condition in which the blood vessels that supply the heart become narrowed or blocked by fatty buildup, reducing oxygen-rich blood flow and making the heart work harder. For investors, it matters because the condition drives demand for medications, medical devices, diagnostics and procedures, can affect healthcare spending and payer policies, and influences the financial prospects of companies involved in cardiovascular care—similar to how a clogged pipe changes maintenance and replacement needs.

coronary CTA medical

"narrowing of coronary arteries (1-69% stenosis) identified on coronary CTA."

Coronary CTA is a noninvasive CT scan that produces detailed pictures of the heart’s blood vessels to check for blockages or narrowing. Think of it as a high-resolution road map for a car engine’s plumbing; it shows where flow might be restricted so doctors can decide whether treatment is needed. Investors watch its use and reimbursement because wider clinical adoption drives demand for scanners, software, and related diagnostic services.

current procedural terminology regulatory

"Category I Current Procedural Terminology (CPT®) payment code 75577"

Current Procedural Terminology (CPT) is a standardized set of codes used to describe medical, surgical and diagnostic services for billing and reporting. Think of it as a universal menu of procedure names and prices that hospitals, doctors, insurers and medical device makers use to communicate what was done and get paid. Changes to CPT codes can alter reimbursement, revenue forecasts and competitive positioning across healthcare companies, so investors watch them closely.

cpt regulatory

"Category I Current Procedural Terminology (CPT®) payment code 75577"

CPT stands for Current Procedural Terminology, a standardized set of codes used to describe medical procedures and services for billing and insurance purposes. For investors, CPT codes determine how and whether healthcare providers get paid for treatments, affecting revenue streams and reimbursement risk; think of them like product barcodes that decide price and payment for clinical services. Changes to codes or coverage policies can directly alter a healthcare company's cash flow and profitability.

relative value units financial

"which established 0.85 relative value units (RVUs) and a combined total of 4.00"

Relative value units are a standardized measure used in healthcare to score the amount of work, resources and overhead associated with a medical service; they are converted into payment amounts by insurers and government programs. For investors, RVUs act like a storefront’s price tag calculator—higher RVUs or higher payment per RVU generally mean more revenue for providers, while changes to RVU values or conversion rates can materially affect earnings and profitability.

rvus financial

"which established 0.85 relative value units (RVUs) and a combined total of 4.00"

Relative value units (RVUs) are a standardized points system used in healthcare to measure the resource intensity of medical services—combining clinician time and effort, practice overhead, and liability risk. Investors care because RVUs are a primary driver of reimbursement from government and many private payers, so shifts in RVU valuation or volume directly affect provider revenue and profitability; think of RVUs as the point score that turns clinical activity into a billing amount.

coronary plaque medical

"earlier, clearer insights into coronary plaque. More patients will benefit"

Coronary plaque is a build-up of fatty, fibrous and sometimes calcified material inside the arteries that supply the heart, like sticky deposits that narrow or harden a pipe. It matters to investors because the amount and type of plaque predict risk of heart attacks and chronic heart disease, which drives demand for drugs, medical devices, diagnostic tests, insurance payouts and can affect workforce productivity and healthcare-related costs across markets.

ivus medical

"tool with 95% agreement to the gold standard, IVUS, using blinded core lab"

Intravascular ultrasound (IVUS) is a medical imaging technique that uses a tiny ultrasound probe on the tip of a thin tube threaded inside blood vessels to produce detailed cross‑sectional pictures of the vessel walls and plaque. For investors, IVUS matters because it can change clinical decisions during procedures—like whether and where to place a stent—affecting procedure outcomes, device sales, training needs, and reimbursement, much like a plumber using an internal camera to decide how to fix a clogged pipe.

AI-generated analysis. How Rhea-AI works. Not financial advice.

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Fourth major national payer releases positive comprehensive coverage for AI-powered Heartflow Plaque Analysis

MOUNTAIN VIEW, Calif., Jan. 06, 2026 (GLOBE NEWSWIRE) -- Heartflow, Inc. (Heartflow) (Nasdaq: HTFL), the leader in AI technology for coronary artery disease (CAD), today announced Heartflow Plaque Analysis is now covered by Aetna across all lines of business, including Commercial, Medicare Advantage, and Aetna Better Health Medicaid plans. Aetna is the fourth major national commercial insurer to update its policies to cover Heartflow Plaque Analysis to fully align with the guidelines issued by radiology benefit manager EviCore, following similar decisions by Humana, Cigna, and UnitedHealthcare. Heartflow Plaque Analysis is covered for the majority of insured lives across the United States.

This coverage milestone follows the American Medical Association’s recent implementation of the new Category I Current Procedural Terminology (CPT^®) payment code 75577 for Heartflow Plaque Analysis, effective January 1, 2026, which established 0.85 relative value units (RVUs) and a combined total of 4.00 RVUs for physicians performing the service.

“Aetna’s decision to cover Heartflow Plaque Analysis nationwide is a pivotal step in expanding access to our AI-driven plaque quantification and characterization technology,” said John Farquhar, President and CEO of Heartflow. “With four major commercial payers and Medicare now recognizing the innovation and value of our platform, more clinicians can gain earlier, clearer insights into coronary plaque. More patients will benefit from early detection and precise quantification of plaque with Heartflow Plaque Analysis, leading to more personalized treatment strategies and improved prognostic assessment, helping set a new benchmark for cardiovascular care.”

The updated coverage became effective on December 23, 2025 for Aetna patients with acute or stable chest pain and mild-to-moderate narrowing of coronary arteries (1-69% stenosis) identified on coronary CTA. The policy expands access for patients to AI-driven plaque analysis, supporting earlier diagnosis, personalized risk stratification, and more precise management of CAD.

The new CPT code was issued in response to increased utilization of AI-powered plaque quantification and characterization technology like Heartflow Plaque Analysis and strong clinical evidence supporting its value. Together, broader national payer coverage and Category I reimbursement position the Heartflow platform as the highest-value pathway in cardiac CT, expanding access and supporting practical adoption in clinical practice.

Heartflow’s continued advancement of Heartflow Plaque Analysis builds on the real-world evidence demonstrated in the landmark DECIDE Registry data, the largest prospective registry evaluating the clinical impact of Heartflow Plaque Analysis on medical management decisions. The DECIDE registry showed that more than 50% of patients had their medical management changed when Heartflow Plaque Analysis with Heartflow Plaque Staging* was added compared to their management based on CCTA alone.¹ A retrospective analysis of symptomatic patients from a cohort of the FISH&CHIPS Study presented at the AHA Scientific Sessions 2025 provided the largest validation to date of the Heartflow Plaque Staging framework based on total plaque volume measurement as a predictor of future heart attacks or cardiovascular death.²

Heartflow Plaque Analysis is the only FDA-cleared, AI-powered plaque quantification tool with 95% agreement to the gold standard, IVUS, using blinded core lab adjudication.³

About Heartflow’s Technology and Research
Heartflow’s technology is redefining precision cardiovascular care through clinically-proven AI and the world’s largest coronary imaging dataset. Heartflow has been adopted by more than 1,400 institutions globally and continues to strengthen its commercial presence to make this cutting-edge solution more widely available to an increasingly diverse patient population. Backed by ACC/AHA guidelines and supported by more than 600 peer-reviewed publications, Heartflow has redefined how clinicians manage care for over 500,000 patients worldwide.⁴ Key benefits include:

• Proprietary data pipeline: Built from more than 160 million annotated CTA images, Heartflow’s data foundation powers advanced AI models that deliver highly accurate, reproducible insights across diverse patient populations.
• Extensive clinical and real-world validation: Heartflow’s AI-driven solutions have been validated through clinical evidence in over 100 studies assessing over 365,000 patients. Proven in real-world practice with reproducibility and accuracy, Heartflow’s coronary CTA image acceptance rates exceed 97%.
• Seamless clinical integration via upgraded workflow: Heartflow delivers final quality-reviewed analyses instantly upon order, enabling clinicians to move from diagnosis to decision without delay.
• Quality system, global security and patient-data integrity compliance: Heartflow meets or exceeds leading international standards, including HITRUST, SOC 2 Type 2, ISO 13485, and ISO 27001.

About Heartflow, Inc.
Heartflow is transforming coronary artery disease from the world’s leading cause of death into a condition that can be detected early, diagnosed accurately, and managed for life. The Heartflow One platform uses AI to turn coronary CTA images into personalized 3D models of the heart, providing clinically meaningful, actionable insights into plaque location, volume, and composition and its effect on blood flow — all without invasive procedures. Discover how we’re shaping the future of cardiovascular care at heartflow.com.

Media Contact
Elliot Levy
elevy@heartflow.com

Investor Contact
Nick Laudico
nlaudico@heartflow.com

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¹ DECIDE Registry. Rinehart, et al., presented at SCCT 2025.
² Fairbairn et al., presented at AHA 2025.
³ Ihdayhid A, et al. Radiol Cardiothorac Imaging. 2024. doi: 10.1148/ryct.230312 and internal bridging study with ICC correlation between first generation and second generation Plaque Analysis algorithm.
⁴ Gulati, et al. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation & Diagnosis of Chest Pain. J Am Coll Cardiol.
*Heartflow Plaque Analysis is an FDA-cleared device. Heartflow Plaque Staging is an investigational-only framework, and its safety and effectiveness have not been reviewed by the FDA.

FAQ

AI-generated questions and answers. How Rhea-AI works. Not financial advice.

What does Aetna coverage mean for Heartflow (HTFL) patients and clinicians?

Aetna’s nationwide coverage effective Dec 23, 2025 expands access for patients with acute or stable chest pain and 1–69% stenosis, enabling broader clinical use.

How does the new CPT code 75577 affect Heartflow reimbursement for HTFL services?

Category I CPT 75577 effective Jan 1, 2026 sets physician valuation at 0.85 RVUs and a combined total of 4.00 RVUs, supporting standardized reimbursement.

Which payers now cover Heartflow Plaque Analysis for HTFL?

Four major commercial payers (Aetna, Humana, Cigna, UnitedHealthcare) and Medicare have updated policies to cover Heartflow Plaque Analysis.

When did Aetna’s Heartflow coverage become effective for eligible patients?

The updated Aetna coverage became effective on December 23, 2025 for the specified patient population.

What clinical evidence supports Heartflow Plaque Analysis for HTFL?

The DECIDE Registry reported that adding Heartflow Plaque Analysis changed medical management in more than 50% of patients; a study validated Plaque Staging as a predictor of events.

How accurate is Heartflow Plaque Analysis compared with invasive imaging?

Heartflow Plaque Analysis is reported as FDA-cleared with 95% agreement to the IVUS gold standard using blinded core lab adjudication.