Computerized Tomography (CT) imaging, also known as CAT scanning (Computed Axial Tomography) provides images of a combination of soft tissues, bones and blood vessels. The CT scan is based on the x-ray principal. As x-rays pass through the body, they are absorbed at differing levels, creating a profile of x-ray beams that is registered on film.

In the absence of signs or symptoms of a disease or condition, or in the absence of conventional diagnostic studies (i.e., standard x-ray and/or ultrasound), a CT scan will not be considered medically necessary.

The following guidelines apply when multiple CT scans are performed on the same day:

• A separate payment may be made for a CT scan of the orbits, the sella turcica, the outer, middle, or inner ear, or the maxillofacial area in addition to a CT scan of the head/brain.
• A separate allowance should not be made for CT of the posterior fossa when performed with a CT scan of the head/brain. Itemized charges should be combined under code 70450, 70460, or 70470 as appropriate.
• A separate payment may be made for CT of the pelvic region in addition to CT of the abdomen. CT scan of the pelvis includes payment for studies of the male or female internal reproductive organs.
• CT scan of the abdomen/retroperitoneum includes payment for studies of the kidney, adrenals, liver, and pancreas.

When an enhanced study is performed on the same day as an unenhanced study of the same organ,  the appropriate combination code should be used.

When both MRI and a computed tomography CT scan are performed on the same day for the same anatomic area, payment should be made for the CT scan. The MRI may only be paid if supporting documentation is submitted to establish medical necessity for both studies.

Xenon Cerebral Blood Flow CT Study (76499)
When a Xenon cerebral blood flow CT study (code 76499) is reported on the same day as a conventional CT study of the head or brain (codes 70450-70470), payment may be made for the conventional CT study. However, the Xenon study is not generally accepted by the medical community as clinically useful in diagnosing or treatment. When reported, it is denied as not medically necessary. A participating, preferred, or network provider cannot bill the member for the denied service.

Coronary Artery Scanning by Electron Beam Computed Tomography (EBCT)(S8092)
Coronary artery scanning or cardiovascular CT is generally performed using an electron beam scanning system rather than a standard CT scanner. Coronary artery CT scanning or cardiovascular CT should be reported with code S8092. Coronary artery scanning is considered an experimental/investigational procedure. Scientific evidence in published medical literature has not demonstrated the efficacy of coronary artery scanning, or whether it's as effective as other commonly used studies (for example, echocardiography). As such, it is not eligible for payment. A participating, preferred, or network provider cannot bill the member for the denied service.

The standard CT imaging method uses a scanner with an x-ray tube to produce an image. The electron beam CT (EBCT) scanning system uses high speed tomographic technology and rapid scan times to image an anatomic structure. An electron beam scanning system is known by various names such as: electron beam computed tomography (EBCT), ultrafast CT, rapid acquisition x-ray CT, cine CT, or high speed computed x-ray tomography.

For information on CT angiography (CTA) for coronary artery evaluation (code S8093), see Mountain State Medical Policy Bulletin X-54.

NOTE:

This policy is designed to address medical guidelines that are appropriate for the majority of individuals with a particular disease, illness, or condition. Each person's unique clinical circumstances may warrant individual consideration, based on review of applicable medical records.

Coronary artery scanning or cardiovascular CT using an electron beam CT (EBCT) scanning system is eligible under code S8092 when performed for the diagnosis of coronary artery disase (414.00, 414.01).

PRN References

04/1998, Xenon-enhanced CT Studies considered investigational
06/1998, Electron Beam Computed Tomography not covered
12/1998, Computed tomography of the coronary arteries not covered
02/2000, CT scans: report the services, not the method
06/2000, New reporting guidelines for coronary artery scanning by EBCT
06/2000, Guidelines revised for Xenon cerebral blood flow CT studies
07/2000, MRI and CT studies performed on the same day, (Special Bulletin)

Coronary Artery Scanning

Electron Beam Computed Tomography and Coronary Artery Disease: Scanning for coronary artery calcification, Mayo Clinic Proc., Vol. 71, 4/96

Comparison of Electron Beam Computed Tomography with Intracoronary Ultrasound and Coronary Angiography for Detection of Coronary Atherosclerosis, The Journal of the American College of Cardiology, Vol. 30, No. 1, 7/97

Electron Beam Computed Tomographic Coronary Calcium Score Cutpoints and Severity of Associated Angiographic Lumen Stenosis, The Journal of the American College of Cardiology, Vol. 29, No. 7, 6/97

Relation of electron beam computed tomography screening for coronary calcium to cardiovascular risk and disease: a review, Coronary Artery Disease, Vol. 7, No. 5, 5/96

High Coronary Artery Calcium Scores Pose an Extremely Elevated Risk for Hard Events, The Journal of the American College of Cardiology, Vol. 39, No. 2, 01/2002

Current Results and New Developments of Coronary Angiography with Use of Contrast-Enhanced Computed Tomography of the Heart, Mayo Clinic Proceedings, Vol. 77, 01/2002

Differential Coronary Calcification on Electron-Beam CT Between Syndrome X and Coronary Artery Disease in Patients with Chronic Stable Angina Pectoris, Chest, 11/2001

Do conventional risk factors predict subclinical coronary artery disease?, Results from the Prospective Army Coronary Calcium Project, American Heart Journal, 03/2001

Usefulness of Electron-Beam Computed Tomography, The American Journal of Cardiology, Vol. 89(4A), 02/2002

ECRI Target Fact Sheet titled “Electron-beam computed tomography (EBCT) for coronary artery disease (CAD) screening,” 08/2001

Coronary Artery Calcium and Its Relationship to Coronary Artery Disease, Cardiology Clinics, Vol. 21, 11/2003

Cost-Effectiveness of Using Electron Beam Computed Tomography to Identify Patients at Risk for Clinical Coronary Artery Disease, American Heart Journal, Vol. 148, 07/2004

Using the Coronary Artery Calcium Score to Predict Coronary Heart Disease Events, Archives of Internal Medicine, Vol. 164, 06/2004

Coronary Age as a Risk Factor in the Modified Framingham Risk Score, BioMed Central Medical Imaging, 04/2004

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, The American Journal of Cardiology, Vol. 93, 02/2004

Lack of Usefulness of Electron Beam Computed Tomography for Detecting Coronary Allograft Vasculopathy, The American Journal of Cardiology, Vol. 93, 02/2004

United States Preventive Services Task Force recommendations on screening for coronary heart disease, American Family Physician, Vol. 69, 06/2004

American College of Cardiology/American Heart Association Expert Consensus Document on Electron-Beam Computed Tomography for the Diagnosis and Prognosis of Coronary Artery Disease, Journal of the American College of Cardiology, Vol. 36, 06/2000