Computed Tomography to Detect Coronary Artery Calcification
Description of Procedure or Service
Coronary artery calcium (CAC) has been recognized to be associated with coronary artery disease (CAD) on the basis of anatomic studies. The development of fast computed tomography (CT) scanners has allowed the measurement of CAC in clinical practice. CAC has been evaluated in several clinical settings. The most widely studied indication is for the use of CAC in the prediction of future risk for CAD in patients with subclinical disease, with the goal of instituting appropriate risk-reducing therapy (eg, statin treatment; lifestyle modifications) to improve outcomes. In addition, CAC has been evaluated in patients with symptoms potentially consistent with CAD, but in whom a diagnosis is unclear.
Several types of fast computed tomography (CT) imaging, including electron beam computed tomography (EBCT) and spiral CT, allow the quantification of calcium in coronary arteries. Coronary artery calcium (CAC) is associated with coronary artery disease (CAD). The use of CAC scores has been studied in the prediction of future risk of CAD and in the diagnosis of CAD in symptomatic patients.
Electron-beam computed tomography (EBCT: also known as ultrafast CT) and spiral CT (or helical CT) may be used as an alternative to conventional CT scanning due to their faster throughput. In both methods, speed of image acquisition gives them unique value for imaging of the moving heart. The rapid image acquisition time virtually eliminates motion artifact related to cardiac contraction, permitting visualization of the calcium in the epicardial coronary arteries. EBCT software permits quantification of calcium area and density, which are translated into calcium scores. Calcium scores have been investigated as a technique for detecting coronary artery calcification, both as a diagnostic technique in symptomatic patients to rule out an atherosclerotic etiology of symptoms or, in asymptomatic patients, as an adjunctive method for risk stratification for coronary artery disease.
EBCT and multi-detector computed tomography (MDCT) were initially the primary fast CT methods for measurement of coronary artery calcification. A fast CT study for coronary artery calcium measurement generally takes 10 to 15 minutes and requires only a few seconds of scanning time. More recently, CT angiography has been used to assess coronary calcium. Because of the basic similarity between EBCT and CT angiography in measuring coronary calcium, it is expected that CT angiography provides information on coronary calcium that is similar to EBCT.
CT scan‒derived coronary calcium measures have been used to evaluate coronary atherosclerosis. Coronary calcium is present in coronary atherosclerosis, but atherosclerosis detected may or may not be causing ischemia or symptoms. Coronary calcium measures may be correlated with the presence of critical coronary stenoses or serve as a measure of the patient’s proclivity toward atherosclerosis and future coronary disease. Thus, coronary calcium could serve as a variable to be used in a risk assessment calculation to determine appropriate preventive treatment in asymptomatic patients. Alternatively, in other clinical scenarios, coronary calcium scores might help determine whether there is an atherosclerotic etiology or component to the presenting clinical problem in symptomatic patients, thus helping to direct further workup for the clinical problem. In this second scenario, a calcium score of zero usually indicates that the patient’s clinical problem is unlikely to be due to atherosclerosis and that other etiologies should be more strongly considered. In neither case does the test determine a specific diagnosis. Most clinical studies have examined the use of coronary calcium for its potential use in estimating the risk of future coronary heart disease (CHD) events.
Coronary calcium levels can be expressed in many ways. The most common method is the Agatston score, which is a weighted summed total of calcified coronary artery area observed on CT. This value can be expressed as an absolute number, commonly ranging from 0 (low risk) to 400 (high risk). These values can be translated into age and sex-specific percentile values. Different imaging methods and protocols will produce different values based on the specific algorithm used to create the score, but the correlation between any 2 methods appears to be high, and scores from 1 method can be translated into scores from a different method.
***Note: This Medical Policy is complex and technical. For questions concerning the technical language and/or specific clinical indications for its use, please consult your physician.
Policy
BCBSNC will not provide coverage for Computed Tomography to Detect Coronary Artery Calcification. The use of computed tomography (e.g., electron beam CT, spiral or helical CT, multislice or multi-detector CT) to detect coronary artery calcification is considered investigational. BCBSNC does not cover investigational services or procedures.
Benefits Application
Please refer to Certificate for availability of benefits. This policy relates only to the services or supplies described herein. Benefits may vary according to benefit design, therefore certificate language should be reviewed before applying the terms of the policy.
When Computed Tomography to Detect Coronary Artery Calcification is covered
Not applicable.
When Computed Tomography to Detect Coronary Artery Calcification is not covered
Computed tomography to detect coronary artery calcification is considered investigational for all services, including:
- detection of coronary artery calcification as a screening examination for asymptomatic patients
- as a diagnostic study in symptomatic patients
- assessment of coronary artery bypass graft patency
- measurement of cardiac perfusion.
Policy Guidelines
The evidence for individuals who are asymptomatic with risk of CAD who receive CAC scoring, includes multiple systematic reviews, randomized controlled trials and, nonrandomized observational studies. Relevant outcomes are overall survival, test accuracy and validity, morbid events, and resource utilization. There is extensive evidence on the predictive value of coronary artery calcium (CAC) score screening for cardiovascular disease among asymptomatic patients, and this evidence has demonstrated that scanning has incremental predictive accuracy above traditional risk factor measurement. However, evidence from high quality studies demonstrating that the use of CAC score measurement in clinical practice leads to changes in patient management or in individual risk behaviors that improve cardiac outcomes is limited. A meta-analysis of RCTs reported no significant change in coronary risk profile, downstream testing, or revascularization following screening using CAC scoring compared to no CAC scoring. The evidence is insufficient to determine that the technology results in an improvement in the net health outcome.
The evidence for individuals with signs and/or symptoms suggestive of CAD who receive CAC scoring before other diagnostic testing, includes systematic reviews, RCTs and nonrandomized observational studies. Relevant outcomes are overall survival, test accuracy and validity, morbid events, and resource utilization. CAC scoring has potential as a diagnostic test to rule out coronary artery disease (CAD) in patients presenting with symptoms or as a “gatekeeper” test before invasive imaging is performed. Evidence from observational studies has suggested that negative results on CAC scoring rule out coronary artery disease with good reliability. However, the evidence has been inconsistent, with some studies reporting lack of value when using a zero calcium score to rule out CAD. Further prospective trials would be needed to demonstrate that such a strategy is effective in practice and is at least as effective as alternative strategies for ruling out CAD. To demonstrate that use of calcium scores improves the efficiency or accuracy of the diagnostic workup of symptomatic patients, rigorous studies that define exactly how coronary calcium scores are used in combination with other tests to triage patients would be necessary. The evidence is insufficient to determine that the technology results in an improvement in the net health outcome.
Billing/Coding/Physician Documentation Information
This policy may apply to the following codes. Inclusion of a code in this section does not guarantee that it will be reimbursed. For further information on reimbursement guidelines, please see Administrative Policies on the Blue Cross Blue Shield of North Carolina web site at www.bcbsnc.com. They are listed in the Category Search on the Medical Policy search page.
Applicable codes: S8092, 75571, 0623T, 0624T, 0625T, 0626T
BCBSNC may request medical records for determination of medical necessity. When medical records are requested, letters of support and/or explanation are often useful, but are not sufficient documentation unless all specific information needed to make a medical necessity determination is included.
Scientific Background and Reference Sources
From Policy titled: Electron Beam Computed Tomography for Imaging of Coronary Artery Disease
BCBSA Medical Policy Reference Manual - 12/95
Blue Cross Blue Shield Association Policy, 6.01.03, reviewed 7/31/97
Medical Policy Advisory Group, 11/98
Medical Policy Advisory Group 12/2/1999
Specialty Matched Consultant Advisory Panel - 8/2000
Medical Policy Advisory Group 10/2000
BCBSA Medical Policy Reference Manual 6.01.03, 8/15/01
Specialty Matched Consultant Advisory Panel - 9/2002
BCBSA Medical Policy Reference Manual [Electronic Version]. 6.01.03, 04/29/03
ECRI Health Technology Forecast. (2004, April 9). Computed tomography for cardiovascular disease screening. Retrieved on April 12, 2004.
Walsh CR, Larson MG, Kupka JM, Levy D, Vasan RS, Benjamin EJ, et al. (February 2004). Association of aortic valve calcium detected by electron beam computed tomography with echocardiographic aortic valve disease and with calcium deposits in the coronary arteries and thoracic aorta. Am J Cardiol, 15;93(4), 421-5. Retrieved here on April 12, 2004.
American Medical Association Report 10 of the Council on Scientific Affairs (A-03). Commercialized Medical Screening. Retrieved on April 13, 2004.
Specialty Matched Consultant Advisory Panel - 6/2004
ECRI Target Report #529 (2004, August) Electron-beam computed tomography (EBCT) for coronary artery disease (CAD) screening. Retrieved on December 9, 2005.
For Policy renamed: Computed Tomography to Detect Coronary Artery Calcification
BCBSA Medical Policy Reference Manual [Electronic Version]. 6.01.03, 12/14/05
BCBSA Medical Policy Reference Manual [Electronic Version]. 6.01.03, 4/17/07
Institute for Clinical Systems Improvement (ICSI). Electron-Beam and Helical Computed Tomography for Coronary Artery Disease. Technology Assessment # 34. Bloomington, MN: ICSI; May 2004. Retrieved 10/ 23/07.
California Technology Assessment Forum (CTAF). Utility of Coronary Artery Calcium Measurement in Cardiovascular Disease. San Francisco, CA: CTAF; February 2005. Retrieved 10/23/07.
Waugh N, Black C, Walker S, McIntyre L, Cummins E, Hillis G. The effectiveness and cost-effectiveness of computed tomography screening for coronary artery disease: systematic review. Health Technol Assess. 2006 Oct;10(39):1-60. Retrieved 1/7/08.
Medical Advisory Secretariat, Ontario Ministry of Health and Long-Term Care for the Ontario Health Technology Advisory Committee. (May 2007). Multidetector Computed Tomography for Coronary Artery Disease Screening in Asymptomatic Populations. Retrieved 10/23/07.
BCBSA Medical Policy Reference Manual [Electronic Version]. 6.01.03, 7/09/09
National Heart, Lung, and Blood Institute (NHLBI). Adding Coronary Calcium Score to Traditional Risk Factors Improves Risk Assessment for Heart Disease. April 2010. Retrieved on September 15, 2010.
National Institutes of Health (NIH). Multi-Ethnic Study of Atherosclerosis (MESA). Retrieved on September 15, 2010.
U.S. Preventive Services Task Force (USPSTF). Using Nontraditional Risk Factors In Coronary Heart Disease Risk Assessment. October 2009. Retrieved on September 15, 2010.
Specialty Matched Consultant Advisory Panel review 10/2010
Greenland P, Alpert JS, Beller GA et al. 2010 ACCF/AHA guideline for assessment of cardiovascular risk in asymptomatic adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2010; 56(25):e50-103. Retrieved on August 15, 2011.
Rozanski A, Gransar H, Shaw LJ, et al. Impact of coronary artery calcium scanning on coronary risk factors and downstream testing. J Amer Coll Cardiol, 2011;57:1622-1632. Retrieved on August 15, 2011.
BCBSA Medical Policy Reference Manual [Electronic Version]. 6.01.03, 7/14/11
U.S. Preventive Services Task Force (USPSTF). Screening for Coronary Heart Disease. Updated September 2011. Retrieved on September 26,2011.
Specialty Matched Consultant Advisory Panel review 10/2011
BCBSA Medical Policy Reference Manual [Electronic Version]. 6.01.03, 7/12/12
Ferket BS, Genders TS, Colkesen EB et al. Systematic review of guidelines on imaging of asymptomatic coronary artery disease. J Am Coll Cardiol. 2011; 57(15):1591-600.
Specialty Matched Consultant Advisory Panel review 10/2012
Whelton SP, Nasir K, Blaha MJ et al. Coronary artery calcium and primary prevention risk assessment: what is the evidence? An updated meta-analysis on patient and physician behavior. Circ Cardiovasc Qual Outcomes 2012; 5(4):601-7.
BCBSA Medical Policy Reference Manual [Electronic Version]. 6.01.03, 6/13/13
Specialty Matched Consultant Advisory Panel review 10/2013
Medical Director review 10/2013
Taylor AJ, Cerqueira M, Hodgson JM et al. NCCF/SCCT/ACR/AHA/ASE/ASNC/NASCI/SCAI/SCMR 2010 appropriate use criteria for cardiac computed tomography. A report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, the Society of Cardiovascular Computed Tomography, the American College of Radiology, the American Heart Association, the American Society of Echocardiography, the American Society of Nuclear Cardiology, the North American Society for Cardiovascular Imaging, the Society for Cardiovascular Angiography and Interventions, and the Society for Cardiovascular Magnetic Resonance.
Budoff MJ, Mohlenkamp S, McClelland R et al. A comparison of outcomes with coronary artery calcium scanning in unselected populations: the Multi-Ethnic Study of Atherosclerosis (MESA) and Heinz Nixdorf RECALL study (HNR). J Cardiovasc Comput Tomogr 2013; 7(3):182-91.
Polonsky TS, McClelland RL, Jorgensen NW et al. Coronary artery calcium score and risk classification for coronary heart disease prediction. JAMA 2010; 303(16):1610-6.
Laudon DA, Behrenbeck TR, Wood CM et al. Computed tomographic coronary artery calcium assessment for evaluating chest pain in the emergency department: long-term outcome of a prospective blind study. Mayo Clin Proc 2010; 85(4):314-22.
BCBSA Medical Policy Reference Manual [Electronic Version]. 6.01.03, 5/22/14
Specialty Matched Consultant Advisory Panel review 11/2014
Senior Medical Director review 11/2014
BCBSA Medical Policy Reference Manual [Electronic Version]. 6.01.03, 5/21/15
Specialty Matched Consultant Advisory Panel review 10/2015
Medical Director review 10/2015
BCBSA Medical Policy Reference Manual [Electronic Version]. 6.01.03, 9/2016
Specialty Matched Consultant Advisory Panel review 10/2016
Medical Director review 10/2016
BCBSA Medical Policy Reference Manual [Electronic Version]. 6.01.03, 9/2017
Specialty Matched Consultant Advisory Panel review 10/2017
Medical Director review 10/2017
BCBSA Medical Policy Reference Manual [Electronic Version]. 6.01.03, 9/2018
Specialty Matched Consultant Advisory Panel review 10/2018
Medical Director review 10/2018
BCBSA Medical Policy Reference Manual [Electronic Version]. 6.01.03, 9/2019
Specialty Matched Consultant Advisory Panel review 10/2019
Medical Director review 10/2019
BCBSA Medical Policy Reference Manual [Electronic Version]. 6.01.03, 9/2020
Specialty Matched Consultant Advisory Panel review 10/2020
Medical Director review 10/2020
BCBSA Medical Policy Reference Manual [Electronic Version]. 6.01.03, 10/2021
Specialty Matched Consultant Advisory Panel review 10/2021
Medical Director review 10/2021
Specialty Matched Consultant Advisory Panel review 10/2022
Medical Director review 10/2022
Specialty Matched Consultant Advisory Panel review 10/2023
Medical Director review 10/2023
Bell KJL, White S, Hassan O, et al. Evaluation of the Incremental Value of a Coronary Artery Calcium Score Beyond Traditional Cardiovascular Risk Assessment: A Systematic Review and Meta-analysis. JAMA Intern Med. Jun 01 2022; 182(6): 634-642. PMID 35467692
Sarwar A, Shaw LJ, Shapiro MD, et al. Diagnostic and prognostic value of absence of coronary artery calcification. JACC Cardiovasc Imaging. Jun 2009; 2(6): 675-88. PMID 19520336
Han D, Hartaigh BÓ, Gransar H, et al. Incremental prognostic value of coronary computed tomography angiography over coronary calcium scoring for major adverse cardiac events in elderly asymptomatic individuals. Eur Heart J Cardiovasc Imaging. Jun 01 2018; 19(6): 675-683. PMID 28977374
Multi-Ethnic Study of Atherosclerosis (MESA). About MESA. https://www.mesanhlbi.org/aboutMESA.aspx.
Cainzos-Achirica M, Miedema MD, McEvoy JW, et al. Coronary Artery Calcium for Personalized Allocation of Aspirin in Primary Prevention of Cardiovascular Disease in 2019: The MESA Study (Multi-Ethnic Study of Atherosclerosis). Circulation. May 12 2020; 141(19): 1541-1553. PMID 32233663
Gepner AD, Young R, Delaney JA, et al. Comparison of Carotid Plaque Score and Coronary Artery Calcium Score for Predicting Cardiovascular Disease Events: The Multi-Ethnic Study of Atherosclerosis. J Am Heart Assoc. Feb 14 2017; 6(2). PMID 28196817
Budoff MJ, Young R, Burke G, et al. Ten-year association of coronary artery calcium with atherosclerotic cardiovascular disease (ASCVD) events: the multi-ethnic study of atherosclerosis (MESA). Eur Heart J. Jul 01 2018; 39(25): 2401-2408. PMID 29688297
Blaha MJ, Cainzos-Achirica M, Greenland P, et al. Role of Coronary Artery Calcium Score of Zero and Other Negative Risk Markers for Cardiovascular Disease: The Multi-Ethnic Study of Atherosclerosis (MESA). Circulation. Mar 01 2016; 133(9): 849-58. PMID 26801055
Ferencik M, Pencina KM, Liu T, et al. Coronary Artery Calcium Distribution Is an Independent Predictor of Incident Major Coronary Heart Disease Events: Results From the Framingham Heart Study. Circ Cardiovasc Imaging. Oct 2017; 10(10). PMID 28956774
Nakanishi R, Li D, Blaha MJ, et al. All-cause mortality by age and gender based on coronary artery calcium scores. Eur Heart J Cardiovasc Imaging. Nov 2016; 17(11): 1305-1314. PMID 26705490
Elias-Smale SE, Wieberdink RG, Odink AE, et al. Burden of atherosclerosis improves the prediction of coronary heart disease but not cerebrovascular events: the Rotterdam Study. Eur Heart J. Aug 2011; 32(16): 2050-8. PMID 21606087
Erbel R, Möhlenkamp S, Moebus S, et al. Coronary risk stratification, discrimination, and reclassification improvement based on quantification of subclinical coronary atherosclerosis: the Heinz Nixdorf Recall study. J Am Coll Cardiol. Oct 19 2010; 56(17): 1397-406. PMID 20946997
Lehmann N, Erbel R, Mahabadi AA, et al. Value of Progression of Coronary Artery Calcification for Risk Prediction of Coronary and Cardiovascular Events: Result of the HNR Study (Heinz Nixdorf Recall). Circulation. Feb 13 2018; 137(7): 665-679. PMID 29142010
Won KB, Chang HJ, Niinuma H, et al. Evaluation of the predictive value of coronary artery calcium score for obstructive coronary artery disease in asymptomatic Korean patients with type 2 diabetes mellitus. Coron Artery Dis. Mar 2015; 26(2): 150-6. PMID 25356815
Kelkar AA, Schultz WM, Khosa F, et al. Long-Term Prognosis After Coronary Artery Calcium Scoring Among Low-Intermediate Risk Women and Men. Circ Cardiovasc Imaging. Apr 2016; 9(4): e003742. PMID 27072301
Chang SM, Nabi F, Xu J, et al. Value of CACS compared with ETT and myocardial perfusion imaging for predicting long-term cardiac outcome in asymptomatic and symptomatic patients at low risk for coronary disease: clinical implications in a multimodality imaging world. JACC Cardiovasc Imaging. Feb 2015; 8(2): 134-44. PMID 25677886
Johnson JE, Gulanick M, Penckofer S, et al. Does knowledge of coronary artery calcium affect cardiovascular risk perception, likelihood of taking action, and health-promoting behavior change?. J Cardiovasc Nurs. 2015; 30(1): 15-25. PMID 24434820
Silverman MG, Blaha MJ, Krumholz HM, et al. Impact of coronary artery calcium on coronary heart disease events in individuals at the extremes of traditional risk factor burden: the Multi-Ethnic Study of Atherosclerosis. Eur Heart J. Sep 01 2014; 35(33): 2232-41. PMID 24366919
Gibson AO, Blaha MJ, Arnan MK, et al. Coronary artery calcium and incident cerebrovascular events in an asymptomatic cohort. The MESA Study. JACC Cardiovasc Imaging. Nov 2014; 7(11): 1108-15. PMID 25459592
Jacobs PC, Gondrie MJ, van der Graaf Y, et al. Coronary artery calcium can predict all-cause mortality and cardiovascular events on low-dose CT screening for lung cancer. AJR Am J Roentgenol. Mar 2012; 198(3): 505-11. PMID 22357989
Jacobs PC, Gondrie MJ, Mali WP, et al. Unrequested information from routine diagnostic chest CT predicts future cardiovascular events. Eur Radiol. Aug 2011; 21(8): 1577-85. PMID 21603881
Gupta A, Lau E, Varshney R, et al. The Identification of Calcified Coronary Plaque Is Associated With Initiation and Continuation of Pharmacological and Lifestyle Preventive Therapies: A Systematic Review and Meta-Analysis. JACC Cardiovasc Imaging. Aug 2017; 10(8): 833-842. PMID 28797402
Mamudu HM, Paul TK, Veeranki SP, et al. The effects of coronary artery calcium screening on behavioral modification, risk perception, and medication adherence among asymptomatic adults: a systematic review. Atherosclerosis. Oct 2014; 236(2): 338-50. PMID 25128971
O'Malley PG, Feuerstein IM, Taylor AJ. Impact of electron beam tomography, with or without case management, on motivation, behavioral change, and cardiovascular risk profile: a randomized controlled trial. JAMA. May 07 2003; 289(17): 2215-23. PMID 12734132
Chaikriangkrai K, Palamaner Subash Shantha G, Jhun HY, et al. Prognostic Value of Coronary Artery Calcium Score in Acute Chest Pain Patients Without Known Coronary Artery Disease: Systematic Review and Meta-analysis. Ann Emerg Med. Dec 2016; 68(6): 659-670. PMID 27765299
Lo-Kioeng-Shioe MS, Rijlaarsdam-Hermsen D, van Domburg RT, et al. Prognostic value of coronary artery calcium score in symptomatic individuals: A meta-analysis of 34,000 subjects. Int J Cardiol. Jan 15 2020; 299: 56-62. PMID 31229262
Lubbers M, Dedic A, Coenen A, et al. Calcium imaging and selective computed tomography angiography in comparison to functional testing for suspected coronary artery disease: the multicentre, randomized CRESCENT trial. Eur Heart J. Apr 14 2016; 37(15): 1232-43. PMID 26746631
Pursnani A, Chou ET, Zakroysky P, et al. Use of coronary artery calcium scanning beyond coronary computed tomographic angiography in the emergency department evaluation for acute chest pain: the ROMICAT II trial. Circ Cardiovasc Imaging. Mar 2015; 8(3). PMID 25710925
Chaikriangkrai K, Velankar P, Schutt R, et al. Additive prognostic value of coronary artery calcium score over coronary computed tomographic angiography stenosis assessment in symptomatic patients without known coronary artery disease. Am J Cardiol. Mar 15 2015; 115(6): 738-44. PMID 25604930
Hulten E, Bittencourt MS, Ghoshhajra B, et al. Incremental prognostic value of coronary artery calcium score versus CT angiography among symptomatic patients without known coronary artery disease. Atherosclerosis. Mar 2014; 233(1): 190-5. PMID 24529143
Dharampal AS, Rossi A, Dedic A, et al. Restriction of the referral of patients with stable angina for CT coronary angiography by clinical evaluation and calcium score: impact on clinical decision making. Eur Radiol. Oct 2013; 23(10): 2676-86. PMID 23774892
Yoon YE, Chang SA, Choi SI, et al. The absence of coronary artery calcification does not rule out the presence of significant coronary artery disease in Asian patients with acute chest pain. Int J Cardiovasc Imaging. Feb 2012; 28(2): 389-98. PMID 21347595
Gottlieb I, Miller JM, Arbab-Zadeh A, et al. The absence of coronary calcification does not exclude obstructive coronary artery disease or the need for revascularization in patients referred for conventional coronary angiography. J Am Coll Cardiol. Feb 16 2010; 55(7): 627-34. PMID 20170786
Yerramasu A, Lahiri A, Venuraju S, et al. Diagnostic role of coronary calcium scoring in the rapid access chest pain clinic: prospective evaluation of NICE guidance. Eur Heart J Cardiovasc Imaging. Aug 2014; 15(8): 886-92. PMID 24513880
ten Kate GJ, Caliskan K, Dedic A, et al. Computed tomography coronary imaging as a gatekeeper for invasive coronary angiography in patients with newly diagnosed heart failure of unknown aetiology. Eur J Heart Fail. Sep 2013; 15(9): 1028-34. PMID 23759285
Specialty Matched Consultant Advisory Panel review 10/2024
Medical Director review 10/2024
Policy Implementation/Update Information
From Policy titled: Electron Beam Computed Tomography for Imaging of Coronary Artery Disease
11/93 Evaluated: Investigational for detection of coronary artery calcification, assessment of coronary artery bypass graft patency and measurement of cardiac perfusion.
6/96 Reaffirmed: National Association reviewed 12/95. No changes.
9/98 Reaffirmed. Association reviewed 7/31/97, no changes.
6/99 Reformatted, Description of procedure revised, Medical Term Definitions added.
12/99 Reaffirmed, Medical Policy Advisory Group
10/00 Specialty Matched Consultant Advisory Panel. No change in criteria. System coding changes. Medical Policy Advisory Group review. No change in criteria. Approve.
5/01 Policy key words added.
11/01 Coding format change.
9/02 Specialty Matched Consultant Advisory Panel review. No change to policy criteria.
1/03 Code S8092 added to policy. Removed 76120 from policy. Added statement to billing and coding section regarding the possible ordering of medical records. System coding changes.
3/04 Benefits Application and Billing/Coding sections updated for consistency.
7/15/04 Specialty Matched Consultant Advisory Panel review with no changes made to policy criteria. References added.
10/14/04 Code S8093 added to the Billing/Coding section.
12/15/05 Code S8093 removed from Billing/Coding section of the policy.
3/30/06 Specialty Matched Consultant Advisory Panel review 2/27/06. No changes made to policy criteria. Description of procedure expanded for clarity. Rationale added to Policy Guidelines. Policy number added to Key Words. References and CPT codes updated.
For Policy renamed: Computed Tomography to Detect Coronary Artery Calcification
7/10/06 Added statement to description "Although most of the research regarding imaging of coronary artery calcification has focused on EBCT, helical or spiral CT and multislice or multi-detector CT have also been used for this purpose." Policy statement clarified to read "the use of computed tomography (e.g., electron beam CT, spiral or helical CT, multislice or multidetector CT) to detect coronary artery calcification is considered investigational." Additional statement added to section When Electron Beam CT is Not Covered that indicates electron beam CT is not covered "as a diagnostic study in symptomatic patients." Rationale for investigational status added to Policy Guidelines section. References updated. (adn)
4/7/08 References updated. Specialty Matched Consultant Advisory Panel review 3/12/08. No change to policy statement. (adn)
5/11/10 Description section extensively revised. Policy Guidelines and References updated. CPT codes 0144T, 0147T, 0149T deleted. CPT code 75571 added to the Billing/Coding section. (adn)
6/22/10 Medical Policy number removed.
11/23/10 Specialty Matched Consultant Advisory Panel review 10/10. Policy Guidelines updated. References updated.(mco)
8/30/11 Updated Policy Guidelines. Updated References. No changes to Policy Statements. (mco)
11/8/11 Specialty Matched Consultant Advisory Panel review 10/2011. References updated. No changes to Policy Statements. (mco)
9/4/12 References updated. No changes to Policy Statements. (mco)
10/30/12 Specialty Matched Consultant Advisory Panel review 10/2012. References updated. Policy Guidelines updated. (mco)
7/30/13 Description section updated. References updated. No changes to Policy Statement. (mco)
11/12/13 Specialty Matched Consultant Advisory Panel review 10/2013. Medical Director review 10/2013. No changes to Policy Statements. (mco)
7/15/14 Description section updated. Policy Guidelines updated. References updated. No changes to Policy Statement. (mco)
1/13/15 References updated. Specialty Matched Consultant Advisory Panel review 11/2014. Senior Medical Director review 11/2014. Added CPT codes: 75572, 75573, 75574. No changes to Policy statement. (td)
3/10/15 Billing/Coding section updated to remove CPT codes: 75572, 75573, 75574. (td)
7/28/15 Description section updated. Policy Guidelines section updated. References updated. Policy Statements remain unchanged. (td)
12/30/15 References updated. Specialty Matched Consultant Advisory Panel review 10/29/2015. Medical Director review 10/2015. (td)
11/22/16 Specialty Matched Consultant Advisory Panel review 10/2016. Medical Director review 10/2016. (jd)
11/10/17 Policy Guidelines revised; no change to policy intent. References updated. Specialty Matched Consultant Advisory Panel review 10/2017. Medical Director review 10/2017. (jd)
11/9/18 References updated. Specialty Matched Consultant Advisory Panel review 10/2018. Medical Director review 10/2018. (jd)
10/29/19 References updated. Specialty Matched Consultant Advisory Panel review 10/2019. Medical Director review 10/2019. (jd)
11/10/20 References updated. Specialty Matched Consultant Advisory Panel review 10/2020. Medical Director review 10/2020. (jd)
12/31/20 The following codes were added to the Billing/Coding section, effective 1/1/21: 0623T, 0624T, 0625T, 0626T. (jd)
11/2/21 References updated. Specialty Matched Consultant Advisory Panel review 10/2021. Medical Director review 10/2021. (jd)
11/1/22 Policy Guidelines edited for clarity. References updated. No change to policy statement. Specialty Matched Consultant Advisory Panel review 10/2022. Medical Director review 10/2022. (tm)
11/7/23 Description, Policy Guidelines and References updated. Specialty Matched Consultant Advisory Panel review 10/2023. Medical Director review 10/2023. (tm)
11/13/24 Description and References updated. Specialty Matched Consultant Advisory Panel review 10/2024. Medical Director review 10/2024. (tm)
Disclosures:
Medical policy is not an authorization, certification, explanation of benefits or a contract. Benefits and eligibility are determined before medical guidelines and payment guidelines are applied. Benefits are determined by the group contract and subscriber certificate that is in effect at the time services are rendered. This document is solely provided for informational purposes only and is based on research of current medical literature and review of common medical practices in the treatment and diagnosis of disease. Medical practices and knowledge are constantly changing and BCBSNC reserves the right to review and revise its medical policies periodically.
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