SCCT Spotlight on Blue Shield of California Coverage Policy for Coronary CTA
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SCCT is pleased to highlight Blue Shield of California’s recently revised coverage policy for Coronary CTA. This policy, updated in February 2017, now indicates that Coronary CTA may be considered medically necessary for the evaluation of patients with chest pain (without known coronary artery disease) in the acute (emergency department) setting, and for stable chest pain patients in the outpatient setting.  The policy also maintains coverage for the evaluation of anomalous (native) coronary arteries.

“We are now entering a world where cardiovascular CT is getting the recognition that it deserves based on all of the randomized trial data,” said SCCT President  Dr. Leslee J. Shaw. “We believe that greater utilization of cardiovascular CT can markedly improve patient outcomes and result in greater diagnostic certainty for physicians that will result in optimal care of patients. This is a new world where the evidence trumps and patients will benefit with this more advanced and effective tool for cardiovascular testing.”

This policy is the direct result of the robust and increasing evidence base to support the clinical utility and appropriate use of Coronary CTA.  Further, it is the result of continued dialogue between SCCT members and payer representatives. 

“SCCT has worked closely with payers, scientists, and clinicians to advance the field,” said Dr. Matthew J. Budoff, FSCCT.  “Given the large number of randomized trials that have been completed demonstrating benefit of Coronary CTA over standard of care or functional imaging, it is rewarding to see Coronary CTA now covered with comparable approvals to functional stress testing such as stress echo or nuclear.  We have seen changes recently with improved coverage with Humana, United, Aetna, and most recently Blue Cross/Blue Shield.” 

SCCT encourages its members to contact their local Blues plans to advocate for expansions in Coronary CTA coverage, using the recent example of Blue Shield of California. SCCT will continue to advocate for appropriate coverage expansion and will be pleased to provide members with resources to assist in working with local payers. 

“Blue Shield of California should be commended for this significant expansion of coverage,” said Dr. Budoff. “I am pleased that Blue Shield of California was receptive to expanding coverage after a careful review of the literature. I value the dialogue with my local payers and look forward to continued engagement as the literature evolves even more.”

For more information, please contact Carrie Kovar at ckovar@scct.org.

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