CMS Reverses Decision and Issues New Outpatient CPT Code for Ultrasound-Based QTscan

Use of the QTscan device for outpatient diagnostic breast ultrasound exams will be reimbursable for Medicare beneficiaries in 2027, according to the final 2027 Medicare Hospital Outpatient Prospective Payment System (OPPS) rule.

The dedicated CPT code 1079T became effective on October 1. The Centers for Medicare and Medicaid Services (CMS) assigned the CPT code to the Ambulatory Payment Classification (APC) 5522 with an “S” status indicator, enabling separate reimbursement (starting January 1, 2027) for hospital outpatient use of the QTscan, according to QT Imaging, the manufacturer of the QTscan.

The CMS action marked a reversal of a previous decision declining Medicare reimbursement for use of the QTscan.

“CMS’s decision establishes separate Medicare hospital outpatient payment for medically necessary, physician-ordered diagnostic QTscan examinations and removes the reimbursement uncertainty,” noted Raluca Dinu, PhD, the chief executive officer at QT Imaging. “We are now focused on translating this progress into broader clinical adoption, supporting providers with coding and billing guidance, strengthening our engagement with Medicare and commercial payers, and expanding the clinical evidence demonstrating QTscan’s diagnostic value.”