Effective June 22, 2018
CT for Coronary Calcium Scoring (CPT 75571)
CT Calcium Scoring for asymptomatic CAD Screening
- Standalone test is considered investigational in asymptomatic patients with any degree of CAD risk.
- Medicare policies consider that there is insufficient evidence based data to support performance of Coronary Calcium Scoring.
- Texas Heart Attack Preventive Screening Law (HR 1290) mandates that insurers in Texas cover either a calcium scoring study (CPT 75571 or HCPCS S8092) every five years for certain populations. To qualify, the following must apply:
a. Must be a Texas resident.
b. Must be a member of a fully-insured Texas health plan.
c. Must be a man age 45 to 75 or a woman age 55 to 75.
d. Must have either diabetes or a Framingham cardiac risk score of intermediate or higher.
e. Must not have had a calcium scoring study or a carotid intima-media thickness study within the past 5 years.
Coronary CT Angiogram (CPT 75574) Indications
Symptomatic individuals who have a ‘low’ or ‘intermediate’ pretest probability of CAD
Low’ or ‘intermediate’ pre-test probability of coronary disease with persistent symptoms after a stress test.
Replace performance of invasive coronary angiogram in individuals with low risk of CAD (i.e. Pre op non-coronary surgery).
For symptomatic individuals, evaluate post-CABG graft patency when only graft patency is a concern and imaging of the native coronary artery anatomy is not needed, such as in early graft failure.
For symptomatic individuals with unsuccessful conventional coronary angiography (i.e. locate a coronary artery, graft, identify the course of an anomalous coronary artery).
- To identify whether bypass grafts are located directly beneath the sternum, so that alternative ways to enter the chest can be planned.
Evaluate coronary artery anomalies and other complex congenital heart disease of cardiac chambers or great vessels.
Anomalous coronary artery(ies) suspected for diagnosis or to plan treatment and less than age 40 with a history that includes one or more of the following:
- Persistent exertional chest pain and normal stress test
- Full sibling(s) with history of sudden death syndrome before age 30 or with documented anomalous coronary artery.
- Resuscitated sudden death and contraindications for conventional coronary angiography.
- Unexplained new onset of heart failure.
Evaluation of newly diagnosed congestive heart failure or cardiomyopathy.
- No prior history of coronary artery disease, the ejection fraction is less than 50 % and low or intermediate risk on the pre-test probability assessment and;
- No exclusions to cardiac CT angiography;
- No cardiac catheterization, SPECT, cardiac PET, or stress echocardiogram has been performed since the diagnosis of congestive heart failure or cardiomyopathy.
Ventricular tachycardia (6 beat runs or greater) if CCTA will replace conventional invasive coronary angiography.
Equivocal coronary artery anatomy on conventional cardiac catheterization.
Newly diagnosed dilated cardiomyopathy.
Preoperative assessment of the coronary arteries in patients who are going to undergo surgery for aortic dissection, aortic aneurysm, or valvular surgery if CCTA will replace conventional invasive coronary angiography.
Relative contraindications for Cardiac/Coronary CT:
- Irregular heart rhythms (e.g., atrial fibrillation/flutter, frequent irregular premature ventricular contractions or premature atrial contractions, and high grade heart block)
- Multi focal Atrial Tachycardia
- Inability to lie flat
- Body mass index of 40 or more
- Inability to obtain a heart rate less than 65 beats per minute after beta-blockers
- Inability to hold breath for at least 8 seconds
- Renal Insufficiency
- Asymptomatic patients and routine use in the evaluation of the coronary arteries following heart transplantation
- CCTA should not be performed if there is extensive coronary calcification (calcium score >1000).
- Evaluation of coronary stent patency < 3.0mm
Evaluation of left ventricular function following myocardial infarction or in chronic heart failure
Fractional Flow Reserve by Computed Tomography - 0501T, 0502T, 0503T 0504T
Indications for FFR-CT
To further assess CAD seen on a recent CCTA that is of uncertain physiologic significance
CT Heart – Indications (CPT 75572)
If echocardiogram is inconclusive for:
- Cardiac or pericardial tumor or mass
- Cardiac thrombus
- Pericarditis/constrictive pericarditis
Complications of cardiac surgery.
Cardiac vein identification for lead placement in patients needing left ventricular pacing.
Pulmonary vein isolation procedure (ablation) for atrial fibrillation
Repeated post-procedure between 3-6 months after ablation because of a 1%-2 % incidence of asymptomatic pulmonary vein stenosis.
Recurrent laryngeal nerve palsy due to cardiac chamber enlargement.
Clinical suspicion of arrhythmogenic right ventricular dysplasia or arrhythmogenic cardiomyopathy (ARVD/ARVC), especially if patient has presyncope or syncope if the clinical suspicion is supported by established criteria for ARVD.
Cardiac CT for congenital heart disease (CPT 75573)
Coronary artery anomaly evaluation
- A cardiac catheterization was performed and not all coronary arteries were identified
Thoracic arteriovenous anomaly evaluation
- A cardiac MRI or chest CT angiogram was performed and suggested congenital heart disease
Complex adult congenital heart disease evaluation
- No cardiac CT or cardiac MRI has been performed and there is a contraindication to cardiac MRI
Transcatheter Aortic Valve Replacement (TAVR)
Once the decision has been made for aortic valve replacement, the following may be used to determine if a patient is a candidate for TAVR:
- CTA of chest (CPT 71275), abdomen and pelvis (combination code CPT 74174) are considered appropriate, and Cardiac CT (CPT 75572) may be considered to measure the aortic annulus.
- Coronary CTA (CCTA CPT 75574) may be considered to both measure the aortic annulus and assess the coronary arteries in lieu of heart catheterization.
TAVR follow-up may be approved at 3 months, at one year post procedure, and annually thereafter
- 3D rendering, (CPT 76376/CPT 76377), should not be billed in conjunction with Cardiac CT and CCTA.
- Only one code from the set: CPT 75572 -CPT 75574 can be reported per encounter.
- CPT 75574 includes evaluation of cardiac structure and morphology, when performed; therefore, additional code/s should not be assigned.
- Report CPT 75574 for evaluating coronary artery anomalies.
- Report CPT 75573 for congenital heart disease.
- To evaluate the great vessels, Chest CTA (CPT 71275) can be performed instead of CCTA or in addition to CCTA.
- For anomalous pulmonary venous return, can add CT abdomen and pelvis with contrast (CPT 74177).
Chest CTA (CPT 71275) and CCTA (CPT 75574) are useful in detecting aortic and coronary injury and can help in the evaluation of myocardial and pericardial injury.
Cardiac CT (CPT 75572) can be performed to evaluate anatomy of the pulmonary veins prior to an ablation procedure performed for atrial fibrillation
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