Local Coverage Article Billing and Coding

Billing and Coding: Cardiac Computed Tomography & Angiography (CCTA)

A56691

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Article Information

General Information

Article ID
A56691
Article Title
Billing and Coding: Cardiac Computed Tomography & Angiography (CCTA)
Article Type
Billing and Coding
Original Effective Date
07/11/2019
Revision Effective Date
10/01/2022
Revision Ending Date
N/A
Retirement Date
N/A
AMA CPT / ADA CDT / AHA NUBC Copyright Statement

CPT codes, descriptions and other data only are copyright 2022 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.

Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

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Copyright © 2022, the American Hospital Association, Chicago, Illinois. Reproduced with permission. No portion of the American Hospital Association (AHA) copyrighted materials contained within this publication may be copied without the express written consent of the AHA. AHA copyrighted materials including the UB‐04 codes and descriptions may not be removed, copied, or utilized within any software, product, service, solution or derivative work without the written consent of the AHA. If an entity wishes to utilize any AHA materials, please contact the AHA at 312‐893‐6816.

Making copies or utilizing the content of the UB‐04 Manual, including the codes and/or descriptions, for internal purposes, resale and/or to be used in any product or publication; creating any modified or derivative work of the UB‐04 Manual and/or codes and descriptions; and/or making any commercial use of UB‐04 Manual or any portion thereof, including the codes and/or descriptions, is only authorized with an express license from the American Hospital Association. The American Hospital Association (the "AHA") has not reviewed, and is not responsible for, the completeness or accuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in the preparation of this material, or the analysis of information provided in the material. The views and/or positions presented in the material do not necessarily represent the views of the AHA. CMS and its products and services are not endorsed by the AHA or any of its affiliates.

CMS National Coverage Policy

Title XVIII of the Social Security Act, §1833 (e) prohibits Medicare payment for any claim which lacks the necessary information to process the claim.

Article Guidance

Article Text

The information in this article contains billing, coding or other guidelines that complement the Local Coverage Determination (LCD) for Cardiac Computed Tomography & Angiography (CCTA) L33423.

Refer to the Non-Invasive Fractional Flow Reserve (FFR) for Stable Ischemic Heart Disease L38278 LCD and related billing and coding article A58406 for more information regarding the use of add-on analysis of CCTA.

Coding Information

CPT/HCPCS Codes

Group 1

(4 Codes)
Group 1 Paragraph

CPT Codes

Group 1 Codes
CodeDescription
75571 Ct hrt w/o dye w/ca test
75572 Ct hrt w/3d image
75573 Ct hrt c+ strux cgen hrt ds
75574 Ct angio hrt w/3d image

CPT/HCPCS Modifiers

N/A

ICD-10-CM Codes that Support Medical Necessity

Group 1

(261 Codes)
Group 1 Paragraph

Use of these codes does not guarantee reimbursement. The patient's medical record must document that the coverage criteria in this policy have been met.

Covered ICD-10 Codes for CPT codes 75571, 75572, and 75574.

Group 1 Codes
CodeDescription
A18.84 Tuberculosis of heart
I11.0 Hypertensive heart disease with heart failure
I11.9 Hypertensive heart disease without heart failure
I20.0 Unstable angina
I20.1 Angina pectoris with documented spasm
I20.8 Other forms of angina pectoris
I20.9 Angina pectoris, unspecified
I24.0 Acute coronary thrombosis not resulting in myocardial infarction
I25.10 Atherosclerotic heart disease of native coronary artery without angina pectoris
I25.110 Atherosclerotic heart disease of native coronary artery with unstable angina pectoris
I25.111 Atherosclerotic heart disease of native coronary artery with angina pectoris with documented spasm
I25.112 Atherosclerosic heart disease of native coronary artery with refractory angina pectoris
I25.118 Atherosclerotic heart disease of native coronary artery with other forms of angina pectoris
I25.119 Atherosclerotic heart disease of native coronary artery with unspecified angina pectoris
I25.2 Old myocardial infarction
I25.3 Aneurysm of heart
I25.41 Coronary artery aneurysm
I25.42 Coronary artery dissection
I25.5 Ischemic cardiomyopathy
I25.6 Silent myocardial ischemia
I25.700 Atherosclerosis of coronary artery bypass graft(s), unspecified, with unstable angina pectoris
I25.701 Atherosclerosis of coronary artery bypass graft(s), unspecified, with angina pectoris with documented spasm
I25.702 Atherosclerosis of coronary artery bypass graft(s), unspecified, with refractory angina pectoris
I25.708 Atherosclerosis of coronary artery bypass graft(s), unspecified, with other forms of angina pectoris
I25.709 Atherosclerosis of coronary artery bypass graft(s), unspecified, with unspecified angina pectoris
I25.710 Atherosclerosis of autologous vein coronary artery bypass graft(s) with unstable angina pectoris
I25.711 Atherosclerosis of autologous vein coronary artery bypass graft(s) with angina pectoris with documented spasm
I25.712 Atherosclerosis of autologous vein coronary artery bypass graft(s) with refractory angina pectoris
I25.718 Atherosclerosis of autologous vein coronary artery bypass graft(s) with other forms of angina pectoris
I25.719 Atherosclerosis of autologous vein coronary artery bypass graft(s) with unspecified angina pectoris
I25.720 Atherosclerosis of autologous artery coronary artery bypass graft(s) with unstable angina pectoris
I25.721 Atherosclerosis of autologous artery coronary artery bypass graft(s) with angina pectoris with documented spasm
I25.722 Atherosclerosis of autologous artery coronary artery bypass graft(s) with refractory angina pectoris
I25.728 Atherosclerosis of autologous artery coronary artery bypass graft(s) with other forms of angina pectoris
I25.729 Atherosclerosis of autologous artery coronary artery bypass graft(s) with unspecified angina pectoris
I25.730 Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with unstable angina pectoris
I25.731 Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with angina pectoris with documented spasm
I25.732 Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with refractory angina pectoris
I25.738 Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with other forms of angina pectoris
I25.739 Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with unspecified angina pectoris
I25.750 Atherosclerosis of native coronary artery of transplanted heart with unstable angina
I25.751 Atherosclerosis of native coronary artery of transplanted heart with angina pectoris with documented spasm
I25.752 Atherosclerosis of native coronary artery of transplanted heart with refractory angina pectoris
I25.758 Atherosclerosis of native coronary artery of transplanted heart with other forms of angina pectoris
I25.759 Atherosclerosis of native coronary artery of transplanted heart with unspecified angina pectoris
I25.760 Atherosclerosis of bypass graft of coronary artery of transplanted heart with unstable angina
I25.761 Atherosclerosis of bypass graft of coronary artery of transplanted heart with angina pectoris with documented spasm
I25.762 Atherosclerosis of bypass graft of coronary artery of transplanted heart with refractory angina pectoris
I25.768 Atherosclerosis of bypass graft of coronary artery of transplanted heart with other forms of angina pectoris
I25.769 Atherosclerosis of bypass graft of coronary artery of transplanted heart with unspecified angina pectoris
I25.790 Atherosclerosis of other coronary artery bypass graft(s) with unstable angina pectoris
I25.791 Atherosclerosis of other coronary artery bypass graft(s) with angina pectoris with documented spasm
I25.792 Atherosclerosis of other coronary artery bypass graft(s) with refractory angina pectoris
I25.798 Atherosclerosis of other coronary artery bypass graft(s) with other forms of angina pectoris
I25.799 Atherosclerosis of other coronary artery bypass graft(s) with unspecified angina pectoris
I25.810 Atherosclerosis of coronary artery bypass graft(s) without angina pectoris
I25.811 Atherosclerosis of native coronary artery of transplanted heart without angina pectoris
I25.812 Atherosclerosis of bypass graft of coronary artery of transplanted heart without angina pectoris
I25.82 Chronic total occlusion of coronary artery
I25.84 Coronary atherosclerosis due to calcified coronary lesion
I25.89 Other forms of chronic ischemic heart disease
I25.9 Chronic ischemic heart disease, unspecified
I26.01 Septic pulmonary embolism with acute cor pulmonale
I26.02 Saddle embolus of pulmonary artery with acute cor pulmonale
I26.09 Other pulmonary embolism with acute cor pulmonale
I26.92 Saddle embolus of pulmonary artery without acute cor pulmonale
I26.93 Single subsegmental pulmonary embolism without acute cor pulmonale
I26.94 Multiple subsegmental pulmonary emboli without acute cor pulmonale
I26.99 Other pulmonary embolism without acute cor pulmonale
I27.0 Primary pulmonary hypertension
I27.1 Kyphoscoliotic heart disease
I27.20 Pulmonary hypertension, unspecified
I27.21 Secondary pulmonary arterial hypertension
I27.22 Pulmonary hypertension due to left heart disease
I27.23 Pulmonary hypertension due to lung diseases and hypoxia
I27.24 Chronic thromboembolic pulmonary hypertension
I27.29 Other secondary pulmonary hypertension
I27.81 Cor pulmonale (chronic)
I27.82 Chronic pulmonary embolism
I27.83 Eisenmenger's syndrome
I27.89 Other specified pulmonary heart diseases
I27.9 Pulmonary heart disease, unspecified
I28.0 Arteriovenous fistula of pulmonary vessels
I28.1 Aneurysm of pulmonary artery
I28.8 Other diseases of pulmonary vessels
I28.9 Disease of pulmonary vessels, unspecified
I30.0 Acute nonspecific idiopathic pericarditis
I30.1 Infective pericarditis
I30.8 Other forms of acute pericarditis
I30.9 Acute pericarditis, unspecified
I32 Pericarditis in diseases classified elsewhere
I34.0 Nonrheumatic mitral (valve) insufficiency
I34.1 Nonrheumatic mitral (valve) prolapse
I34.2 Nonrheumatic mitral (valve) stenosis
I34.89 Other nonrheumatic mitral valve disorders
I34.9 Nonrheumatic mitral valve disorder, unspecified
I35.0 Nonrheumatic aortic (valve) stenosis
I35.1 Nonrheumatic aortic (valve) insufficiency
I35.2 Nonrheumatic aortic (valve) stenosis with insufficiency
I35.8 Other nonrheumatic aortic valve disorders
I35.9 Nonrheumatic aortic valve disorder, unspecified
I42.0 Dilated cardiomyopathy
I42.1 Obstructive hypertrophic cardiomyopathy
I42.2 Other hypertrophic cardiomyopathy
I42.3 Endomyocardial (eosinophilic) disease
I42.4 Endocardial fibroelastosis
I42.5 Other restrictive cardiomyopathy
I42.6 Alcoholic cardiomyopathy
I42.7 Cardiomyopathy due to drug and external agent
I42.8 Other cardiomyopathies
I42.9 Cardiomyopathy, unspecified
I43 Cardiomyopathy in diseases classified elsewhere
I44.4 Left anterior fascicular block
I44.5 Left posterior fascicular block
I44.7 Left bundle-branch block, unspecified
I45.2 Bifascicular block
I45.3 Trifascicular block
I45.6 Pre-excitation syndrome
I45.89 Other specified conduction disorders
I46.2 Cardiac arrest due to underlying cardiac condition
I46.8 Cardiac arrest due to other underlying condition
I46.9 Cardiac arrest, cause unspecified
I48.0 Paroxysmal atrial fibrillation
I48.11 Longstanding persistent atrial fibrillation
I48.19 Other persistent atrial fibrillation
I48.20 Chronic atrial fibrillation, unspecified
I48.21 Permanent atrial fibrillation
I48.91 Unspecified atrial fibrillation
I49.01 Ventricular fibrillation
I49.8 Other specified cardiac arrhythmias
I50.1 Left ventricular failure, unspecified
I50.20 Unspecified systolic (congestive) heart failure
I50.21 Acute systolic (congestive) heart failure
I50.22 Chronic systolic (congestive) heart failure
I50.23 Acute on chronic systolic (congestive) heart failure
I50.30 Unspecified diastolic (congestive) heart failure
I50.31 Acute diastolic (congestive) heart failure
I50.32 Chronic diastolic (congestive) heart failure
I50.33 Acute on chronic diastolic (congestive) heart failure
I50.40 Unspecified combined systolic (congestive) and diastolic (congestive) heart failure
I50.41 Acute combined systolic (congestive) and diastolic (congestive) heart failure
I50.42 Chronic combined systolic (congestive) and diastolic (congestive) heart failure
I50.43 Acute on chronic combined systolic (congestive) and diastolic (congestive) heart failure
I50.810 Right heart failure, unspecified
I50.811 Acute right heart failure
I50.812 Chronic right heart failure
I50.813 Acute on chronic right heart failure
I50.814 Right heart failure due to left heart failure
I50.82 Biventricular heart failure
I50.83 High output heart failure
I50.84 End stage heart failure
I50.89 Other heart failure
I50.9 Heart failure, unspecified
I51.7 Cardiomegaly
I70.0 Atherosclerosis of aorta
I71.010 Dissection of ascending aorta
I71.011 Dissection of aortic arch
I71.012 Dissection of descending thoracic aorta
I74.11 Embolism and thrombosis of thoracic aorta
M32.12 Pericarditis in systemic lupus erythematosus
Q20.9 Congenital malformation of cardiac chambers and connections, unspecified
Q22.0 Pulmonary valve atresia
Q22.1 Congenital pulmonary valve stenosis
Q22.2 Congenital pulmonary valve insufficiency
Q22.3 Other congenital malformations of pulmonary valve
Q22.4 Congenital tricuspid stenosis
Q22.5 Ebstein's anomaly
Q22.6 Hypoplastic right heart syndrome
Q22.8 Other congenital malformations of tricuspid valve
Q22.9 Congenital malformation of tricuspid valve, unspecified
Q23.0 Congenital stenosis of aortic valve
Q23.1 Congenital insufficiency of aortic valve
Q23.2 Congenital mitral stenosis
Q23.3 Congenital mitral insufficiency
Q23.4 Hypoplastic left heart syndrome
Q23.8 Other congenital malformations of aortic and mitral valves
Q23.9 Congenital malformation of aortic and mitral valves, unspecified
Q24.0 Dextrocardia
Q24.1 Levocardia
Q24.2 Cor triatriatum
Q24.3 Pulmonary infundibular stenosis
Q24.4 Congenital subaortic stenosis
Q24.5 Malformation of coronary vessels
Q24.8 Other specified congenital malformations of heart
Q24.9 Congenital malformation of heart, unspecified
R07.2 Precordial pain
R94.30 Abnormal result of cardiovascular function study, unspecified
R94.31 Abnormal electrocardiogram [ECG] [EKG]
T82.01XA Breakdown (mechanical) of heart valve prosthesis, initial encounter
T82.01XD Breakdown (mechanical) of heart valve prosthesis, subsequent encounter
T82.01XS Breakdown (mechanical) of heart valve prosthesis, sequela
T82.02XA Displacement of heart valve prosthesis, initial encounter
T82.02XD Displacement of heart valve prosthesis, subsequent encounter
T82.02XS Displacement of heart valve prosthesis, sequela
T82.03XA Leakage of heart valve prosthesis, initial encounter
T82.03XD Leakage of heart valve prosthesis, subsequent encounter
T82.03XS Leakage of heart valve prosthesis, sequela
T82.09XA Other mechanical complication of heart valve prosthesis, initial encounter
T82.09XD Other mechanical complication of heart valve prosthesis, subsequent encounter
T82.09XS Other mechanical complication of heart valve prosthesis, sequela
T82.190A Other mechanical complication of cardiac electrode, initial encounter
T82.190D Other mechanical complication of cardiac electrode, subsequent encounter
T82.190S Other mechanical complication of cardiac electrode, sequela
T82.211A Breakdown (mechanical) of coronary artery bypass graft, initial encounter
T82.211D Breakdown (mechanical) of coronary artery bypass graft, subsequent encounter
T82.211S Breakdown (mechanical) of coronary artery bypass graft, sequela
T82.212A Displacement of coronary artery bypass graft, initial encounter
T82.212D Displacement of coronary artery bypass graft, subsequent encounter
T82.212S Displacement of coronary artery bypass graft, sequela
T82.213A Leakage of coronary artery bypass graft, initial encounter
T82.213D Leakage of coronary artery bypass graft, subsequent encounter
T82.213S Leakage of coronary artery bypass graft, sequela
T82.218A Other mechanical complication of coronary artery bypass graft, initial encounter
T82.218D Other mechanical complication of coronary artery bypass graft, subsequent encounter
T82.218S Other mechanical complication of coronary artery bypass graft, sequela
T82.221A Breakdown (mechanical) of biological heart valve graft, initial encounter
T82.221D Breakdown (mechanical) of biological heart valve graft, subsequent encounter
T82.221S Breakdown (mechanical) of biological heart valve graft, sequela
T82.222A Displacement of biological heart valve graft, initial encounter
T82.222D Displacement of biological heart valve graft, subsequent encounter
T82.222S Displacement of biological heart valve graft, sequela
T82.223A Leakage of biological heart valve graft, initial encounter
T82.223D Leakage of biological heart valve graft, subsequent encounter
T82.223S Leakage of biological heart valve graft, sequela
T82.228A Other mechanical complication of biological heart valve graft, initial encounter
T82.228D Other mechanical complication of biological heart valve graft, subsequent encounter
T82.228S Other mechanical complication of biological heart valve graft, sequela
T82.518A Breakdown (mechanical) of other cardiac and vascular devices and implants, initial encounter
T82.518D Breakdown (mechanical) of other cardiac and vascular devices and implants, subsequent encounter
T82.518S Breakdown (mechanical) of other cardiac and vascular devices and implants, sequela
T82.522A Displacement of artificial heart, initial encounter
T82.522D Displacement of artificial heart, subsequent encounter
T82.522S Displacement of artificial heart, sequela
T82.523A Displacement of balloon (counterpulsation) device, initial encounter
T82.523D Displacement of balloon (counterpulsation) device, subsequent encounter
T82.523S Displacement of balloon (counterpulsation) device, sequela
T82.528A Displacement of other cardiac and vascular devices and implants, initial encounter
T82.528D Displacement of other cardiac and vascular devices and implants, subsequent encounter
T82.528S Displacement of other cardiac and vascular devices and implants, sequela
T82.533A Leakage of balloon (counterpulsation) device, initial encounter
T82.533D Leakage of balloon (counterpulsation) device, subsequent encounter
T82.533S Leakage of balloon (counterpulsation) device, sequela
T82.538A Leakage of other cardiac and vascular devices and implants, initial encounter
T82.538D Leakage of other cardiac and vascular devices and implants, subsequent encounter
T82.538S Leakage of other cardiac and vascular devices and implants, sequela
T82.592A Other mechanical complication of artificial heart, initial encounter
T82.592D Other mechanical complication of artificial heart, subsequent encounter
T82.592S Other mechanical complication of artificial heart, sequela
T82.593A Other mechanical complication of balloon (counterpulsation) device, initial encounter
T82.593D Other mechanical complication of balloon (counterpulsation) device, subsequent encounter
T82.593S Other mechanical complication of balloon (counterpulsation) device, sequela
T82.598A Other mechanical complication of other cardiac and vascular devices and implants, initial encounter
T82.598D Other mechanical complication of other cardiac and vascular devices and implants, subsequent encounter
T82.598S Other mechanical complication of other cardiac and vascular devices and implants, sequela
Z48.21 Encounter for aftercare following heart transplant
Z48.280 Encounter for aftercare following heart-lung transplant
Z94.1 Heart transplant status
Z94.3 Heart and lungs transplant status
Z95.1 Presence of aortocoronary bypass graft
Z95.3 Presence of xenogenic heart valve
Z95.4 Presence of other heart-valve replacement

Group 2

(78 Codes)
Group 2 Paragraph

Covered ICD-10 Codes for CPT code 75573

Group 2 Codes
CodeDescription
P29.38 Other persistent fetal circulation
Q20.0 Common arterial trunk
Q20.1 Double outlet right ventricle
Q20.2 Double outlet left ventricle
Q20.3 Discordant ventriculoarterial connection
Q20.4 Double inlet ventricle
Q20.5 Discordant atrioventricular connection
Q20.6 Isomerism of atrial appendages
Q20.8 Other congenital malformations of cardiac chambers and connections
Q20.9 Congenital malformation of cardiac chambers and connections, unspecified
Q21.0 Ventricular septal defect
Q21.10 Atrial septal defect, unspecified
Q21.23 Complete atrioventricular septal defect
Q21.3 Tetralogy of Fallot
Q21.4 Aortopulmonary septal defect
Q21.8 Other congenital malformations of cardiac septa
Q21.9 Congenital malformation of cardiac septum, unspecified
Q22.0 Pulmonary valve atresia
Q22.1 Congenital pulmonary valve stenosis
Q22.2 Congenital pulmonary valve insufficiency
Q22.3 Other congenital malformations of pulmonary valve
Q22.4 Congenital tricuspid stenosis
Q22.5 Ebstein's anomaly
Q22.6 Hypoplastic right heart syndrome
Q22.8 Other congenital malformations of tricuspid valve
Q22.9 Congenital malformation of tricuspid valve, unspecified
Q23.0 Congenital stenosis of aortic valve
Q23.1 Congenital insufficiency of aortic valve
Q23.2 Congenital mitral stenosis
Q23.3 Congenital mitral insufficiency
Q23.4 Hypoplastic left heart syndrome
Q23.8 Other congenital malformations of aortic and mitral valves
Q23.9 Congenital malformation of aortic and mitral valves, unspecified
Q24.0 Dextrocardia
Q24.1 Levocardia
Q24.2 Cor triatriatum
Q24.3 Pulmonary infundibular stenosis
Q24.4 Congenital subaortic stenosis
Q24.5 Malformation of coronary vessels
Q24.6 Congenital heart block
Q24.8 Other specified congenital malformations of heart
Q24.9 Congenital malformation of heart, unspecified
Q25.0 Patent ductus arteriosus
Q25.1 Coarctation of aorta
Q25.21 Interruption of aortic arch
Q25.29 Other atresia of aorta
Q25.3 Supravalvular aortic stenosis
Q25.40 Congenital malformation of aorta unspecified
Q25.41 Absence and aplasia of aorta
Q25.42 Hypoplasia of aorta
Q25.43 Congenital aneurysm of aorta
Q25.44 Congenital dilation of aorta
Q25.45 Double aortic arch
Q25.46 Tortuous aortic arch
Q25.47 Right aortic arch
Q25.48 Anomalous origin of subclavian artery
Q25.49 Other congenital malformations of aorta
Q25.5 Atresia of pulmonary artery
Q25.6 Stenosis of pulmonary artery
Q25.71 Coarctation of pulmonary artery
Q25.72 Congenital pulmonary arteriovenous malformation
Q25.79 Other congenital malformations of pulmonary artery
Q25.8 Other congenital malformations of other great arteries
Q25.9 Congenital malformation of great arteries, unspecified
Q26.0 Congenital stenosis of vena cava
Q26.1 Persistent left superior vena cava
Q26.2 Total anomalous pulmonary venous connection
Q26.3 Partial anomalous pulmonary venous connection
Q26.4 Anomalous pulmonary venous connection, unspecified
Q26.8 Other congenital malformations of great veins
Q26.9 Congenital malformation of great vein, unspecified
Q27.30 Arteriovenous malformation, site unspecified
Q27.4 Congenital phlebectasia
Q28.0 Arteriovenous malformation of precerebral vessels
Q28.1 Other malformations of precerebral vessels
Q28.8 Other specified congenital malformations of circulatory system
R94.30 Abnormal result of cardiovascular function study, unspecified
R94.31 Abnormal electrocardiogram [ECG] [EKG]

ICD-10-CM Codes that DO NOT Support Medical Necessity

Group 1

Group 1 Paragraph

All ICD-10 codes not listed under "ICD-10 Codes that Support Medical Necessity" will be denied as not medically necessary.

Group 1 Codes

N/A

ICD-10-PCS Codes

N/A

Additional ICD-10 Information

N/A

Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

N/A

Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.

N/A

Other Coding Information

N/A

Revision History Information

Revision History DateRevision History NumberRevision History Explanation
10/01/2022 R10

Under ICD-10-CM Codes that Support Medical Necessity Group 1: Codes deleted I34.8, I71.01 and added I25.112, I25.702, I25.712, I25.722, I25.732, I25.752, I25.762, I25.792, I34.89, I71.010, I71.011 and I71.012. Under ICD-10-CM Codes that Support Medical Necessity Group 2: Codes deleted Q21.1, Q21.2 and added Q21.10, Q21.23. This revision is due to the Annual ICD-10-CM Update and will become effective on 10/1/22.

01/01/2022 R9

Under CPT/HCPCS Codes Group 1: Codes the description was revised for code 75573. This revision is due to the Annual CPT/HCPCS update and is effective on 1/1/22.

01/01/2021 R8

Under CPT/HCPCS Codes Group 1: Codes deleted codes 0623T, 0624T, 0625T and 0626T. Under ICD-10 Codes that Support Medical Necessity Group 1: Paragraph deleted codes 0623T, 0624T, 0625T and 0626T. These codes were inadvertently added to these sections.

01/01/2021 R7

Under ICD-10 Codes that Support Medical Necessity Group 1: Paragraph added codes 0623T, 0624T, 0625T and 0626T, and removed code 75573.

01/01/2021 R6

Under CPT/HCPCS Codes Group 1: Codes added codes 0623T, 0624T, 0625T and 0626T. This revision is due to the Q1 2021 CPT/HCPCS code update and has a retroactive effective date of 1/1/21.

11/21/2020 R5

Under Article Text added the sentence that reads: “Refer to the Non-Invasive Fractional Flow Reserve (FFR) for Stable Ischemic Heart Disease L38278 LCD and related billing and coding article A58406 for more information regarding the use of add-on analysis of CCTA.” Under CPT/HCPCS Codes – Group 1: Codes deleted codes 0501T, 0502T, 0503T and 0504T. Under ICD-10 Codes that Support Medical Necessity – Group 1: Paragraph added code 75573 and deleted codes 0501T, 0502T, 0503T and 0504T in the second sentence.

10/17/2019 R4

This article is being revised in order to adhere to CMS requirements per chapter 13, section 13.5.1 of the Program Integrity Manual, to remove all coding from LCDs and incorporate into related Billing and Coding Articles. Title XVIII of the Social Security Act, §1833(e) was removed from the CMS National Coverage Policy section of the related Cardiac Computed Tomography & Angiography (CCTA) L33423 LCD and placed in this article.

10/01/2019 R3

Under Covered ICD-10 Codes Group 1: Codes added ICD-10 Codes I26.93, I26.94, I48.11, I48.19, I48.20 and I48.21. Under Covered ICD-10 Codes Group 1: Codes deleted ICD-10 Codes I48.1 and I48.2. This revision is due to the Annual ICD-10 Code Update and becomes effective on 10/1/2019.

07/11/2019 R2

All ICD-10 codes and verbiage listed in the Non-Covered ICD-10 Codes Group 1: Paragraph and Codes sections were moved to the Covered ICD-10 Group 2: Paragraph and Codes sections as it was inadvertently placed in the wrong section.

Under Non-Covered ICD-10 Codes Group 1: Paragraph added the verbiage “All ICD-10 codes not listed under "ICD-10 Codes that Support Medical Necessity" will be denied as not medically necessary.”

07/11/2019 R1

All coding located in the Coding Information section has been removed from the related Cardiac Computed Tomography & Angiography (CCTA) L33423 LCD and added to this article.

Associated Documents

Related National Coverage Documents
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Rules and Regulations URLs
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CMS Manual Explanations URLs
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Other URLs
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Keywords

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