Cigna Expands Coverage for Coronary Plaque AI Analysis, Extending Access to Millions

Cigna has announced that it will begin nationwide coverage of coronary plaque analysis software, marking another major milestone in the adoption of artificial intelligence in cardiovascular imaging. The move, which takes effect October 1, follows similar action earlier this year by UnitedHealthcare and positions CT-based plaque analysis as a standard component of diagnostic care for patients with chest pain.

The Bloomfield, Connecticut-based payer said the new policy will apply to more than 16 million members across both commercial and Medicare Advantage plans. It builds on July guideline updates by EviCore, Cigna’s radiology benefits manager, which endorsed coronary CT angiography (CCTA) plaque analysis as an appropriate tool for guiding management in certain patient populations.

Specifically, the coverage applies to individuals with acute or stable chest pain and evidence of mild to moderate stenosis (1%–69%) on CCTA. In these scenarios, the AI-powered software provides a more detailed assessment of coronary plaque burden and composition, offering insights beyond simple stenosis measurements. Proponents argue this can help clinicians more precisely stratify risk and tailor treatment strategies, particularly in patients who may not yet qualify for invasive angiography.

The decision aligns Cigna with UnitedHealthcare, which already extended nationwide coverage for the technology, and Medicare, which reimburses plaque analysis under existing policies. Taken together, these commitments mean more than 61 million Americans now have access to AI-driven plaque characterization as part of their diagnostic pathway. A new CPT Category I code for coronary plaque analysis, set to go into effect January 1, is expected to further streamline reimbursement and accelerate adoption.

John Farquhar, MBA, president and CEO of Heartflow, welcomed the news, calling it a significant validation of the technology’s role in cardiovascular care. “Cigna’s decision to cover Heartflow Plaque Analysis is a testament to the power of our technology to positively impact care for its members across the United States,” he said in a September 22 statement.

Heartflow is one of several vendors offering the software, which uses advanced image processing and AI to quantify plaque volume, type, and distribution on CT. The company also announced it has secured U.S. Food and Drug Administration 510(k) clearance for its next-generation plaque analysis algorithm. The updated version includes enhanced visualization tools, a broader nomogram, and more detailed 3D color-coded mapping of plaque characteristics.

These advancements come at a time of growing momentum for Heartflow. The California-based firm recently completed an upsized initial public offering on the Nasdaq, raising $364 million to support further innovation and market expansion.

For clinicians, the expanded payer support represents an opportunity to incorporate plaque analysis more routinely into care pathways, especially for patients with chest pain who may fall into a diagnostic gray zone. By improving the accuracy of CCTA, the technology has the potential to reduce unnecessary invasive procedures, optimize preventive therapy, and improve long-term outcomes.

As adoption grows, attention is likely to shift toward how best to integrate plaque analysis into daily practice, balancing its diagnostic value with workflow and training considerations. For now, the broad coverage decisions by Medicare and two of the nation’s largest private insurers send a strong signal that AI-driven plaque assessment is poised to become a mainstay of cardiovascular imaging.