Standard ankle-brachial index testing measures a single pressure ratio between the arm and ankle to check for peripheral arterial disease. While this test has been a clinical mainstay for decades, arterial calcification can make it unreliable in patients with diabetes. The CMAT Advantage system from HealthWright Technologies combines ABI with TBI, pulse volume recording, autonomic nervous system analysis, and sudomotor function testing in a single 7- to 10-minute exam — giving independent physicians a comprehensive vascular and neurological assessment that standard ABI alone cannot provide.
What Does Standard ABI Testing Measure?
Standard ABI testing calculates the ratio of systolic blood pressure at the ankle to systolic blood pressure in the arm. A normal ABI falls between 1.00 and 1.40, while values of 0.90 or below indicate peripheral arterial disease. The test uses a handheld Doppler probe and a blood pressure cuff, typically taking 12 to 20 minutes per patient.
However, standard ABI has well-documented limitations. Medial arterial calcification — common in diabetic, elderly, and chronic kidney disease patients — artificially elevates ankle pressures, producing falsely normal or elevated ABI values. The American Heart Association notes that ABI may be unreliable when values exceed 1.40, yet these are precisely the high-risk patients who need accurate testing most.
How Does the CMAT Advantage System Differ From Standard ABI?
The CMAT Advantage system is a multi-parameter diagnostic platform, built on FDA-cleared component devices, that performs five distinct assessments in a single patient visit:
- Ankle-Brachial Index (ABI): Standard vascular ratio measurement for macrovascular PAD evaluation
- Toe-Brachial Index (TBI): Uses digital arteries that resist calcification, maintaining diagnostic accuracy in diabetic patients where standard ABI fails
- Pulse Volume Recording (PVR): Records the arterial waveform, which stays readable when calcification makes the pressure values unreliable
- Heart Rate Variability (HRV) and Ewing Tests: Evaluates autonomic nervous system function to detect cardiac autonomic neuropathy
- Sudomotor Function Testing: Measures sweat gland nerve function via galvanic skin response to identify small fiber neuropathy
Where standard ABI provides a single data point, CMAT Advantage delivers a comprehensive cardiovascular and neurological risk profile — all within 7 to 10 minutes and without requiring a vascular lab or specialized technician.
Why Is Standard ABI Unreliable in Diabetic Patients?
Medial arterial calcification is common in patients with diabetes; it stiffens vessel walls and prevents the artery from compressing normally under a blood pressure cuff. This produces falsely elevated ABI readings, which can mask peripheral arterial disease in patients with diabetes.
The CMAT Advantage addresses this limitation through volume plethysmography and TBI measurement. Digital arteries in the toes resist calcification far longer than tibial arteries, so TBI stays informative when ankle pressures are unreliable. For independent physicians serving diabetic populations, this distinction directly affects clinical outcomes and reduces the risk of missed PAD diagnoses.
What CPT Codes Apply to CMAT Advantage Testing?
The individual diagnostic tests performed during a CMAT Advantage exam are billable under established CPT codes:
- CPT 93923: Non-invasive physiologic studies of the extremity arteries (brachial and ankle pressures, pulse volume recording, and ABI).
- CPT 95921 and 95923: Autonomic nervous system function testing (cardiovagal HRV and Ewing tests; sudomotor)
Medicare covers these tests when performed for appropriate clinical indications with documented medical necessity. Independent practices using the CMAT Advantage bill established CPT codes for the components performed when each is medically necessary; reimbursement varies by payer. Select and document codes based on the studies actually performed, and confirm coverage with your MAC. Visit our partnership page for detailed reimbursement guidance.
How Does CMAT Advantage Improve Practice Workflow?
Standard ABI testing typically requires manual Doppler operation and separate documentation. The CMAT Advantage automates the testing protocol with standardized sensor placement, which reduces operator-to-operator variability. Key workflow advantages include:
- Automated testing: Consistent, reproducible results without specialized vascular technician training
- Single-session comprehensive assessment: Five test modalities in 7 to 10 minutes versus scheduling multiple appointments
- CMAT Advantage software: On-system reporting for result review and chart documentation, producing a PDF report the physician signs and then prints, emails or uploads to the EMR
- Report documentation: Automated report generation that supports the physician’s signed interpretation and the chart record
Which Patients Benefit Most From CMAT Advantage Over Standard ABI?
CMAT Advantage provides the greatest clinical value over standard ABI for patients with risk factors for both macrovascular and microvascular disease. Priority patient populations include:
- Patients with Type 2 diabetes, especially those with 10+ years duration
- Patients with chronic kidney disease and suspected arterial calcification
- Patients presenting with unexplained neuropathy symptoms
- Patients with multiple cardiovascular risk factors (hypertension, hyperlipidemia, smoking history)
- Patients where standard ABI returns borderline or elevated (>1.40) results
For these patients, a standard ABI alone may miss significant vascular or autonomic pathology. The CMAT Advantage multi-parameter approach is intended to support identification of treatable conditions at an earlier, more manageable stage.
Frequently Asked Questions
Is the CMAT Advantage system FDA-cleared?
The CMAT Advantage system is built on FDA-cleared component devices manufactured by LD Technology, including the 510(k)-cleared TBL-ABI module (K173696). There is no single integrated “CMAT Advantage” clearance; clearance applies to the underlying component devices. Those devices are FDA-cleared, not FDA-approved — the 510(k) pathway demonstrates substantial equivalence to existing legally marketed devices.
Can my existing staff operate the CMAT Advantage?
Yes. HealthWright Technologies provides complete training and implementation support with every CMAT Advantage system. The automated testing protocol does not require a certified vascular technologist, making it practical for independent practices without dedicated vascular lab staff.
Does Medicare cover CMAT Advantage testing?
The individual diagnostic tests performed by the CMAT Advantage are covered by Medicare when performed for documented clinical indications. Screening-level tests without documented symptoms or medical necessity are not covered. Proper documentation of clinical indication is essential for reimbursement.
How should practices plan for a CMAT Advantage rollout?
The overall financial picture depends on patient volume, payer mix, and clinical indication, which HealthWright reviews with each practice during a personalized consultation. Reimbursement varies by payer and clinical indication; CMAT Advantage adds objective, billable diagnostic testing to the clinical workflow.
What is the difference between ABI and TBI testing?
ABI measures the blood pressure ratio between the ankle and arm using tibial arteries. TBI measures the ratio using digital arteries in the toes. Because toe arteries resist medial calcification, TBI provides more reliable results in diabetic and elderly patients where ABI values may be falsely elevated.
Ready to upgrade your practice’s diagnostic capabilities? Contact HealthWright Technologies at (678) 322-7146 or email contact@healthwrighttechnologies.com and we will follow up to arrange a demonstration of the CMAT Advantage system. You can also read how PAD testing with CMAT Advantage helps independent practices evaluate peripheral arterial disease earlier.
CPT codes are registered trademarks of the American Medical Association. CPT codes referenced in this article are provided for informational purposes only and do not guarantee reimbursement. Verify code applicability and coverage with the relevant payer and your billing department before submitting claims. This content is for educational purposes and does not constitute medical or billing advice.
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