Computed tomographic angiography (CTA) for the evaluation of coronary arteries is considered eligible for the assessment of suspected congenital anomalies of coronary circulation.

CTA of the coronary arteries for all other clinical indications and applications is considered investigational. CTA using electron beam CT (EBCT) or other rapid imaging CT scanning systems to detect coronary artery calcification (also called calcium scoring) is also considered investigational. There is insufficient scientific evidence to determine whether this procedure improves patient health outcomes. Clinical trials and research studies are also needed to:

• assess the efficacy of CTA as a noninvasive alternative method for evaluating heart and coronary arteries including, but not limited to, obstructive coronary artery disease, coronary artery bypass graft patency, coronary artery aneurysm, and other coronary artery anomalies;
  
  
• document the clinical effectiveness of this technology and correlate the results obtained using CTA vs. conventional angiography and other noninvasive alternatives such as echocardiography, cardiac nuclear imaging and cardiac catheterization; and
  
  
• 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.

A participating, preferred, or network provider can bill the member for a service denied as investigational.

CT angiography for the evaluation of the coronary arteries is not covered when performed as a screening procedure to evaluate asymptomatic patients (patients without signs and/or symptoms of disease or illness). In this case, a participating, preferred, or network provider can bill the member for the denied service.

Description

Contrast-enhanced computed tomographic angiography (CTA) is a noninvasive imaging study that uses intravenously administered contrast material and high-resolution, rapid imaging CT equipment to obtain detailed volumetric images of blood vessels. CTA can image blood vessels throughout the body. However, imaging of the coronary vasculature requires shorter image acquisition times to avoid blurring from the motion of the beating heart.

The intraservice work involved in the performance of coronary CT and CTA studies includes:

• review of scout views of the area to be imaged
• review of noncontrast CT images to localize the vascular phase sequence
• supervision of administration of low or iso-osmolar contrast material
• review of the enhanced phase CT images to ensure adequate anatomic coverage
• prescribe and review delayed images as necessary
• supervise and/or create 2D and 3D reconstructions of the heart and adjacent structures. Interpret and annotate.
• adjust the projection of 3D reconstruction to optimize visualization of anatomy or pathology
• interpret the axial source images of the precontrast arterial and venous phase sequences, as well as the 2D and 3D images, including cine review
• compare to all pertinent available prior studies

The cardiac CT and CTA codes (0145T-0151T) specify "...and further sections" in their terminology. The interpreting physician is responsible for interpreting the complete study, including the heart and coronary vessels, as well as any other abnormalities seen in the field of view.

Advanced CT imaging technologies are capable of acquiring the necessary data at high speeds (16 slice or better) to produce images at greater speed than conventional CT scanners. Examples of rapid imaging, high-resolution, high-speed CT technologies include the electron beam CT (EBCT) scanning system, spiral or helical CT, multi-detector row CT, and multi-slice CT scanning systems. The advanced spatial and temporal resolution features of these CT scanning systems offer a unique method for imaging the coronary arteries and the heart in motion, and for detecting arterial calcification that contributes to coronary artery disease. 

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.

National Blue Cross Blue Shield Medical Policy # 6.01.03

National Blue Cross Blue Shield Medical Policy # 6.01.43

Clinical Examples in Radiology, Vol. 1, Bulletin 2, 2005

Clinical Statement on Noninvasive Cardiac Imaging, American College of Radiology, Radiology and The Journal of the American College of Radiology, June 2005

Clinical Competence Statement on Cardiac Imaging with Computed Tomography and Magnetic Resonance, American College of Cardiology Foundation and the American Heart Association, Journal of the American College of Cardiology, July 2005

Multislice CT: 64 Slices and Beyond, Radiology Management, May/June 2005

Noninvasive Coronary Imaging and Assessment of Left Ventricular Function Using 16-Slice Computed Tomography, American Journal of Cardiology, March 2005

Follow-up of Coronary Artery Bypass Graft Patency by Multislice Computed Tomography, Journal of the American College of Cardiology, May 2005

Introduction to 64-Slice CT and Its Role in Coronary Imaging, Applied Radiology, December 2005

Coronary CT Angiography: A Cardiologist's Perspective, Applied Radiology, December 2005

How To Do Coronary CT Angiography: A Radiologist's Perspective, Applied Radiology, December 2005

CT Evaluation of Congenital Heart Disease in Adults, Applied Radiology, December 2005

Cardiac CT: Beyond the Coronary Arteries, Applied Radiology, December 2005

Imaging of Congenital Coronary Anomalies with Multislice Computed Tomography, Mayo Clinic Procedures, August 2004

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

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

Accuracy of 16-Row Multidetector Computed Tomography for the Assessment of Coronary Artery Stenosis, The Journal of the American Medical Association, July, 2006