Cardiac Computed Tomography (CCT), also called Computed Tomographic Angiography (CTA), for the evaluation of the heart and coronary arteries is eligible for the following indications:

• the assessment of suspected congenital anomalies of coronary circulation;
• evaluation of chest pain;
  • intermediate pre-test probability of CAD; or
  • uninterpretable ECG or unable to exercise; or
  • no ECG changes and serial enzymes negative; or
  • uninterpretable or equivocal stress test;
• evaluation of suspected coronary anomalies;
• assessment of complex congenital heart disease, including anomalies of coronary circulation, great vessels, cardiac chambers and valves;
• evaluation of coronary arteries in patients with new onset heart failure to assess etiology;
• evaluation of cardiac mass (suspected tumor or thrombus);
• patients with technically limited images from echocardiogram, MRI or TEE;
• evaluation of pericardial conditions (pericardial mass, constrictive pericarditis, or complications of cardiac surgery);
• evaluation of pulmonary vein anatomy prior to invasive radiofrequency ablation for atrial fibrillation;
• noninvasive coronary vein mapping prior to placement of biventricular pacemaker;
• noninvasive coronary arterial mapping, including internal mammary artery prior to repeat cardiac surgical revascularization;
• evaluation of suspected aortic dissection or thoracic aortic aneurysm;
• evaluation of suspected pulmonary embolism.

CCT/CTA (codes 0145T-0151T) is eligible for payment when reported with one of the following diagnosis codes. 

411.1
411.81
414.00-414.07
414.10-414.19
415.11
415.19
441.00-441.03
441.1
441.2
441.6
441.7
745.0
745.10-745.19
745.2-745.5
745.60-745.69
745.7-745.9
746.00-746.09
746.1-746.7
746.81-746.89
746.9
747.0
747.10
747.11
747.20-747.29
747.3
747.40-747.42

CCT/CTA of the coronary arteries for all other clinical indications and applications is considered investigational. There is insufficient scientific evidence to determine whether this procedure improves patient health outcomes for other conditions. Mountain State will review the results of clinical trials and research studies when they are published. A participating, preferred, or network provider can bill the member for the denied service. 

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 addition, CCT/CTA using electron beam CT (EBCT) or other rapid imaging CT scanning systems to detect coronary artery calcification (also called calcium scoring) (codes 0144T, S8092) is also considered investigational. 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 Mountain State 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.

This medical policy may not apply to FEP. Medical policy is not an authorization, certification, explanation of benefits, or a contract. Benefits are determined by the Federal Employee Program.

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

2006 Appropriateness Criteria for Cardiac Computed Tomography and Cardiac Magnetic Resonance Imaging

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Multi-detector Row Cardiac Computed Tomography Accurately Quantifies Right and Left Ventricular Size and Function Compared with Cardiac Magnetic Resonance, American Heart Journal, 03/2006

Reimbursement for Chest Pain: Estimates Based on Current Imaging Strategies, Emergency Medicine, 01/2007

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

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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

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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

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