Computed tomographic angiography (CTA) for the evaluation of coronary arteries is considered experimental/investigational and not eligible for reimbursement. A participating, preferred, or network provider can bill the member for services denied as experimental/investigational.

CTA of the coronary arteries is considered experimental/investigational as a noninvasive alternative method for evaluating conditions including, but not limited to, obstructive coronary artery disease, coronary artery bypass graft patency, coronary artery aneurysm, and congenital coronary artery anomalies. Additional data from clinical trials are needed to document the clinical effectiveness of this technology, and to correlate the results obtained using CTA vs. conventional angiography and other noninvasive alternatives. Data is also needed to evaluate the impact on long-term patient outcomes when used in an acute clinical setting (for example, in the emergency room), or to diagnose and treat high-risk patients and patients on cholesterol lowering therapies.

Description

Computed tomographic angiography (CTA) is a noninvasive imaging study that requires the use of intravenously administered contrast material and high-resolution, high-speed (16 slice or better) CT equipment to obtain detailed volumetric images of blood vessels. Advanced rapid imaging technologies, such as electron beam CT (EBCT) and helical CT scanning (also referred to as spiral CT scanning), are used to perform CTA of the coronary arteries. This new generation of CT scanners is capable of acquiring the necessary data to produce images at greater speed than conventional CT technology. It also acquires very thin sections that are necessary to provide adequate spatial resolution for high quality 3-D reconstruction.

Other examples of the enhancements to CT technology include multi-detector row helical CT scanners (MDCT) and multi-slice CT (MSCT). These scanners are equipped with an array of multiple X-ray detectors that can simultaneously image multiple sections of a patient’s anatomy during rapid volumetric image acquisition. These types of scanners can also be used to perform CTA of the coronary arteries.

For additional information on CT scans, see Medical Policy Bulletin X-3.

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.

Under the Federal Employee Program, all services that utilize FDA-approved drugs, devices, or biological products are eligible when intended for the treatment of a serious or life-threatening condition and when medically necessary and appropriate for the patient’s condition. Computed tomographic angiography (CTA) for coronary artery evaluation is considered eligible when determined medically necessary based on the patient’s condition.

National Blue Cross Blue Shield Medical Policy # 6.01.43

Advances in Cardiac Imaging with 16-section CT Systems, Academic Radiology, Vol. 10, No. 4, April 2003

Current Concepts in Multi-Detector Row CT Evaluation of the Coronary Arteries: Principles, Techniques, and Anatomy, Radiographics, October 2003

Electron Beam CT Versus Helical CT Scans for Assessing Coronary Calcification: Current Utility and Future Directions, American Heart Journal, Vol. 146, No. 6, December 2003

Clinical Utility of Computed Tomography and Magnetic Resonance Techniques for Noninvasive Coronary Angiography, Journal of the American College of Cardiology, Vol. 42 (11), December 2003

 Multidetector Computed Tomography Angiography, Endovascular Today, March 2004

Coronary Artery Disease: New Insights Into the Pathophysiology, Prevalence, and Early Detection of a Monster Menace, Seminars in Ultrasound, CT, and MRI, Vol. 25, Issue 2, April 2004

Multidetector-row CT of the Heart, Radiologic Clinics of North America, Vol. 42, No. 3, May 2004