🧠 The 2026 AHA/ASA stroke guidelines just created a reimbursement inflection point that most health systems haven’t noticed yet.
For the first time in 8 years, the AHA/ASA issued a comprehensive rewrite of acute ischemic stroke management. Two changes matter most:
🔹 Thrombectomy eligibility expanded (Class 1) to large-core strokes (ASPECTS 3–5) and basilar occlusions — populations previously excluded. Evidence: SELECT2, ANGEL-ASPECT, ATTENTION, BAOCHE.
🔹 Extended-window IVT (Class 2a/2b, 4.5–9h) now recommended for patients with salvageable penumbra on CTP or MRI-DWI/FLAIR mismatch.
Both expansions increase the patient population requiring CTP-based imaging selection.
💡 Simultaneously, CTP billing transitioned from Category III (0042T — no standardized Medicare payment) to two Category I CPT codes under the Medicare Physician Fee Schedule, effective January 1, 2026:
✅ 70472 — CTP with concurrent CT/CTA (add-on)
✅ 70473 — CTP standalone
Category I codes carry standardized payment rates recognized by Medicare and commercial payers. The reimbursement uncertainty that discouraged CTP adoption at smaller hospitals is significantly reduced.
⚙️ The flywheel: more guideline-eligible patients needing CTP + stable reimbursement for CTP = reduced adoption barriers across the stroke care continuum.
For health systems still running stroke protocols based on 2018 criteria — this is the signal to re-evaluate your clinical pathways, imaging infrastructure, and AI-assisted analysis capabilities.
👇 What changes are you making to your stroke imaging protocols in response?
#StrokeAI #ComprehensiveStrokeCenter #ThrombectomyCapableStrokeCenters #Neurology #EmergencyMedicine #ImagingIT #Neuroradiology #AcuteStrokeReadyHospitals