Cardio Diagnostics Receives Final Medicare Gapfill Payment Rates For Its AI Heart Tests

Cardio Diagnostics Holdings Inc. (NASDAQ:CDIO), an AI-powered precision cardiovascular medicine company, is ending the year on a strong note, announcing the Centers for Medicare and Medicaid Services issued a final gapfill payment rate for its AI-powered Epi+Gen CHD and PrecisionCHD tests that analyze both genetic and epigenetic markers for coronary heart disease, or CHD. 

Cardio Diagnostics said the final gapfill payment rate of $854 for both tests is an increase from the preliminary gapfill payment rates of $350 for Epi+Gen CHD and $684.76 for PrecisionCHD. The company said the final rate will be effective for claims with dates of service on or after Jan. 1.

"We are pleased with the final payment rate," said Meesha Dogan, CEO and co-founder of Cardio Diagnostics. "Obtaining the final rate is a significant step in our efforts to expand access to our advanced cardiovascular tests for Medicare beneficiaries."

Secret Sauce

PrecisionCHD is an AI-powered test designed to aid in the diagnosis of CHD by analyzing both genetic and epigenetic markers. Epi+Gen CHD provides insight into a patient's three-year risk for a CHD event, such as a heart attack. Both tests are performed from a simple blood draw, enabling scalable, accessible and non-invasive cardiovascular assessment, reports the company. The tests already have dedicated CPT Proprietary Laboratory Analysis codes from the American Medical Association that became effective on April 1, 2024.

Diagnosing A Leading Cause Of Death 

Receiving gapfill payment rates is one step closer for Cardio Diagnostics in realizing broad Medicare reimbursement in helping diagnose CHD, which accounted for over 370,000 deaths in the U.S. in 2022. Cardiovascular disease remains the leading cause of death in the U.S., particularly among Americans aged 65 and older. In 2022 alone, over 700,000 Americans died from heart disease. Cardio Diagnostics is on a mission to test as many people as possible and getting broad Medicare reimbursement helps do that. 

Early detection can allow for intervention which could prevent a serious event such as a heart attack or stroke. By identifying the risk and/or the disease at the early stages through tests like Cardio Diagnostics’, it could slow down progression or stop CHD in its tracks. 

Increasing Access

Cardio Diagnostics has been working hard all year to increase access to these tests. Recently it partnered with 15 new provider organizations across the U.S., making its Epi+Gen CHD and PrecisionCHD tests available to their patients. The new provider organizations represent various medical specialties and care models, spanning four major regions including the South, Northeast, Midwest and West. 

Then there's its partnership with YMCA of East Tennessee to create a customized program to help prevent heart disease among its more than 40,000 members and the broader East Tennessee community. Through the partnership, YMCA members will learn proactive steps they can take to prevent and detect heart disease early, as well as get access to Cardio Diagnostics' Epi+Gen CHD and PrecisionCHD clinical tests at a discounted rate.

As providers across the country increasingly adopt evidence-based approaches to helping their patients maintain cardiovascular health, the company said its tests are becoming essential tools for more effective heart health management. With a Medicare final rate set for 2026, and partnerships in the works, Cardio Diagnostics is gearing up for a heart pumping new year. 

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