Should Your Radiology Practice Have a Cardiac Imaging Program?
A look at the pressures shaping cardiac imaging today and the expert guidance practices need to adapt and grow
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As cardiac imaging accelerates in complexity and volume, private radiology practices are confronting a moment that demands both strategic adaptation and smarter use of emerging tools.
“Cardiac imaging in private practice is hitting an inflection point of growth due to a combination of scientific, access and reimbursement pressures,” said Praveen Ranganath, MD, cardiovascular radiologist at Radiology Partners in Dallas. “However, the inherent structures of private practice radiology do not mesh well with the high resource demands of cardiac imaging.”
Dr. Ranganath participated in an RSNA 2025 education session that offered a broader look at cardiac imaging challenges, including key information about how to create a financially viable cardiac imaging practice, how to maximize productivity by using a 3D lab, and tips for how to grow your advanced imaging practice.
Navigating Reimbursement, Consolidation and Advanced Analytics
Dr. Ranganath presented what he referred to as a pragmatic, albeit sobering status update on current private practice cardiac imaging.
Although cardiac CT and MRI volumes are increasing significantly, he noted that reimbursement pressures and health system consolidation are rapidly shifting the site of service from free-standing clinics to hospital-outpatient departments.
“Unlike hospital systems, private radiology groups cannot benefit from the high margin ‘halo effect’ of follow-up procedures like cath lab interventions or transplants,” Dr. Ranganath said. “And yet, advanced analysis can be leveraged for revenue.”
He noted that profitability in a private practice cardiology setting increasingly relies on advanced approaches, such as quantitative coronary plaque analysis and fractional flow reserve derived from CT (FFR-CT). “New Category I codes for FFR-CT and advanced plaque analysis offer substantially higher reimbursement potential compared to standard interpretations,” he said.
However, capturing that revenue requires navigating strict current procedural terminology (CPT) coding rules that limit how cardiac imaging services can be billed.
For example, Dr. Ranganath said cardiac imaging CPT codes cannot be billed as add-on codes because they bundle 3D post-processing. “To offset high labor costs, groups should negotiate separate advanced post-processing fees, with a market rate often exceeding $150 per exam,” Dr. Ranganath asserted. “Alternatively, they should consider off-loading these tasks to centralized 3D labs.”
To thrive, he advised private practices to convert contracts to per-click rates and combine initial CT orders with advanced analysis.
“Practices must also manage the high overhead of ‘cardiac-capable’ equipment, which can carry an upfront price tag of more than $2 million,” he said.
Despite these steep investments, Dr. Ranganath said changes on the reimbursement horizon could help ease pressures and open opportunities. “Hospitals are no longer going to be paid inordinate fees—meaning they will likely be relatively close to those of the clinic. To prepare for that, we need equipment to scan on,” he said.
A Focus on Protocols, Standardization
There is revenue potential from cardiac imaging reimbursement if radiologists are efficient, both on the reading side and on the protocol acquisition and workflow of outpatient offices, according to Melany B. Atkins, MD.
Dr. Atkins is division chief of cardiovascular imaging at Fairfax Radiological Consultants, medical director of advanced cardiac imaging at Inova Health System and medical director of the Fairfax MRI Center in Virginia.
She recommended recruiting physician champions from radiology, cardiology and internal medicine in the early stages of development to secure physician buy in, build clinical trust and elevate the program. Physician champions can transform a cardiac imaging program from a standalone radiology service into an integrated clinical resource, accelerating adoption and reinforcing its relevance across specialties.
Partnering with a vendor can provide support for implementation of new equipment and help secure consistent access to newer technologies as they are developed, resulting in better image quality and maximized protocol development.
To make the most of limited scan time, Dr. Atkins stressed the importance of preparing patients before they arrive. “You only have 15 minutes for a coronary CT, so you can't spend a lot of time giving patients their IV medications on the table,” she said.
“Radiology practices should also communicate well with patients to ensure adequate patient preparation, affording rapid patient throughput as well as using standardized scanning protocols,” Dr. Atkins continued. “Optimizing patient preparation and throughput allows for 15-minute slot times which will increase revenue.”
She underscored that maintaining high diagnostic image quality remains central to these workflow improvements and requires consistent protocols and reporting practices.
To reinforce consistency and facilitate efficiency, Dr. Atkins and her colleagues use CAD-RADS to ensure that everyone has a standardized report with the same language. She also noted that AI integration and advanced imaging techniques will play an important role in the future of cardiac imaging in general. “It's not fully automated, but it's getting a little bit better every year.”
“The leading cause of death in the United States is heart disease. We have to be part of the team to diagnose it.”
— MELANY B. ATKINS, MD
Using a 3D Lab to Maximize Productivity
Building on the need for efficiency, radiology practices can work with a 3D lab to help balance growing clinical volume with the expanding demands of advanced imaging.
A 3D cardiac imaging lab is essential to cardiothoracic imaging teams, producing interactive 3D models that support accurate imaging interpretation and preprocedural planning. By performing upfront analysis of complex studies, they help streamline interpretation and improve overall workflow efficiency.
“A huge thing that makes us productive is the time efficiency we gain with adequate high-end 3D post-processing,” said, Richard L. Hallett II, MD, medical director of the Banner Health 3D Visualization Laboratory, and an associate professor of radiology at the University of Arizona College of Medicine - Phoenix. “We take our output and copy and paste them into reports. You can also have the outputs fed directly into reports, depending on your software systems and your dictation output.”
To boost efficiency, Dr. Hallett and his colleague make their reports directly available to their referring services, saving them the step of going to the PACS. Instead, they can access a shared folder and download their patient’s information in a report.
He noted that quality control and quality assurance performed by a 3D lab with physician oversight saves readers’ time.
“Working with a 3D lab also ensures standardized protocols, adds revenue by capturing CPT billing codes accurately and helps with operational efficiencies,” Dr. Hallett said. “If you can free your technician from doing the processing and have them just scanning patients, you should have time for additional patients,” he said.
As the landscape continues to evolve, Dr. Atkins emphasized that radiology practices have a clear role to play in private practice cardiac imaging, and it requires readiness and resolve. “The leading cause of death in the United States is heart disease,” said Dr. Atkins. “We have to be part of the team to diagnose it.”
For More Information
Access RSNA practice resources, including high-quality data tools, reporting templates, patient-centered care materials and quality improvement resources for your practice.
Learn about activities and opportunities with the RSNA 3D Special Interest Group.
Read previous RSNA News stories on private practice in radiology: