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Local Coverage Determination (LCD)

Cardiac Computed Tomography (CCT) and Coronary Computed Tomography Angiography (CCTA)

L33559

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Proposed LCD
Proposed LCDs are works in progress that are available on the Medicare Coverage Database site for public review. Proposed LCDs are not necessarily a reflection of the current policies or practices of the contractor.

Document Note

Note History

Contractor Information

LCD Information

Document Information

Source LCD ID
N/A
LCD ID
L33559
Original ICD-9 LCD ID
Not Applicable
LCD Title
Cardiac Computed Tomography (CCT) and Coronary Computed Tomography Angiography (CCTA)
Proposed LCD in Comment Period
N/A
Source Proposed LCD
DL33559
Original Effective Date
For services performed on or after 10/01/2015
Revision Effective Date
For services performed on or after 04/01/2022
Revision Ending Date
N/A
Retirement Date
N/A
Notice Period Start Date
02/10/2022
Notice Period End Date
03/31/2022
AMA CPT / ADA CDT / AHA NUBC Copyright Statement

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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.

Current Dental Terminology © 2023 American Dental Association. All rights reserved.

Copyright © 2023, 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.

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Issue

Issue Description

The multidetector helical computed tomography (MDCT) technology requires thin (up to 1 mm) slices, 0.5 to 0.75 mm reconstructions, multiple simultaneous images (e.g. 16, 32, 64 or more slices), and cardiac gating (often requiring beta blockers for ideal heart rate). There is significant post-processing, depending on the number of slices per second for image generation. For coronary artery imaging, the resulting images show a high correlation with stenotic lesions noted on diagnostic cardiac catheterization but more importantly, with atheromas on intracoronary ultrasound.

Current available body of evidence demonstrates that CCTA can reliably rule out the presence of significant coronary artery disease (CAD) in patients with a low to intermediate probability of having CAD and can reliably achieve a high degree of diagnostic accuracy and technical performance necessary to replace conventional angiography.
Issue - Explanation of Change Between Proposed LCD and Final LCD

References to fractional flow reserve (FFR) services were removed from this LCD to a new policy, Non-Invasive Fractional Flow Reserve (FFR) for Stable Ischemic Heart Disease, L39075, effective 04/01/2022.

In addition, based on a comment received, the requirement for a certified registered nurse to supervise the use of intravenous beta blockers or nitrates given prior to a CT coronary angiogram was removed from limitations for the technical portion of the CCTA test.

CMS National Coverage Policy

Language quoted from Center for Medicare and Medicaid Services (CMS), National Coverage Determinations (NCDs) and coverage provisions in interpretive manuals is italicized throughout the policy. NCDs and coverage provisions in interpretive manuals are not subject to the Local Coverage Determination (LCD) Review Process (42 CFR 405.860[b] and 42 CFR 426 [Subpart D]). In addition, an administrative law judge may not review an NCD. See Section 1869(f)(1)(A)(i) of the Social Security Act.

Unless otherwise specified, italicized text represents quotation from one or more of the following CMS sources:

Title XVIII of the Social Security Act (SSA):

Section 1862(a)(1)(A) excludes expenses incurred for items or services which are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.

Section 1833(e) prohibits Medicare payment for any claim which lacks the necessary information to process the claim.

Section 1862 (a)(7) excludes routine physical examinations.

Code of Federal Regulations:

42 CFR Section 410.32 indicates that diagnostic tests may only be ordered by the treating physician (or other treating practitioner acting within the scope of his or her license and Medicare requirements) who furnishes a consultation or treats a beneficiary for a specific medical problem and who uses the results in the management of the beneficiary's specific medical problem. Tests not ordered by the physician (or other qualified non-physician provider) who is treating the beneficiary are not reasonable and necessary (see Sec. 411.15(k)(1) of this chapter).

CMS Publications:

CMS Publication 100-3, National Coverage Determination Manual, Chapter 1
220.1 Computerized Tomography

CMS Publication 100-4, Medicare Claims Processing Manual, Chapter 13
20 Payment Conditions for Radiology Services

CMS Publication 100-9, Contractor Beneficiary and Provider Communication Manual, Chapter 5
20 Correct Coding Initiative

Coverage Guidance

Coverage Indications, Limitations, and/or Medical Necessity

Abstract:

The multidetector helical computed tomography (MDCT) technology requires thin (up to 1 mm) slices, 0.5 to 0.75 mm reconstructions, multiple simultaneous images (e.g. 16, 32, 64 or more slices), and cardiac gating (often requiring beta blockers for ideal heart rate). There is significant post-processing, depending on the number of slices per second for image generation. For coronary artery imaging, the resulting images show a high correlation with stenotic lesions noted on diagnostic cardiac catheterization but more importantly, with atheromas on intracoronary ultrasound.

Current available body of evidence demonstrates that CCTA can reliably rule out the presence of significant coronary artery disease (CAD) in patients with a low to intermediate probability of having CAD and can reliably achieve a high degree of diagnostic accuracy and technical performance necessary to replace conventional angiography.

Indications:

  1. Patient presenting with chest pain syndrome.

    These tests may be used in lieu of an imaging stress test. The clinician must have a high degree of suspicion that CAD is high on the differential diagnosis of the symptoms.

  2. To facilitate the management decision of a patient with an equivocal stress test.

    These tests might be chosen in select patients who have an equivocal stress (or stress imaging) test. The rationale is that a noninvasive coronary anatomic test (CCTA) allows an alternate method of assessing the coronary arteries, which would limit the number of negative invasive coronary angiograms.

  3. When the recurrence of symptoms in patients with known coronary artery disease may be related to progression/exacerbation of underlying disease.

    The use of these tests in this setting would be to evaluate the extent of previously diagnosed coronary artery disease. Patients with known disease may have had remote invasive angiography and/or stress testing to evaluate prior events or symptoms. New or recurrent symptoms may relate to a change in the coronary anatomy that can be assessed with these tests.

  4. When patients with prior bypass surgery or intracoronary artery stent placement present with chest pain or dyspnea.

    Coronary bypass grafts are relatively well seen with these tests. The rationale for the tests would be to determine the patency and severity of possible graft stenoses that may be the source of chest pain. Patients with prior intracoronary stents often present with recurrent chest pain. The rationale for these tests as an alternative to invasive angiography is to rule out in-stent restenosis as the cause of symptoms. (Accurate assessment of in-stent restenosis may be limited by the artifact caused by the stent material itself and the quality of the scan and scanner).

  5. Suspected congenital anomalies of the coronary circulation.

    These tests are used to assess patients suspected of having a congenital coronary anomaly. The cross-sectional nature of this technique allows one to determine accurately both the presence and possible future harm that could result from the anomaly. It is often used after an anomaly has been identified following a different test such as prior invasive coronary angiogram. These tests are used to decide if surgery is indicated and for surgical planning.

  6. The assessment of coronary or pulmonary venous anatomy.

    This application of the tests for the coronary and pulmonary veins is primarily for pre-surgical planning. Coronary venous anatomy can be useful for the cardiologist who needs to place a pacemaker lead in the lateral coronary vein in order to resynchronize cardiac contraction in patients with heart failure. This may be helpful to guide biventricular pacemaker placement.

    Pulmonary vein anatomy can vary from patient to patient. Pulmonary vein catheter ablation can isolate electrical activity from the pulmonary veins and allow for the elimination of recurrent atrial fibrillation. The presence of a pulmonary venous anatomic map may help eliminate procedural complications and allow for the successful completion of the procedure.

  7. The patient undergoing non-coronary artery cardiac surgery.

    Certain patients who have non-coronary artery cardiac surgery (valve or ascending aortic surgery) may need a pre-operative invasive coronary angiogram. The surgical planning may also depend upon the exact location of the coronary arteries. The rationale for the use of CCTA in these patient subsets is to avoid potentially unnecessary invasive testing and still provide appropriate pre-surgical information.

  8. The test may be medically necessary in patients presenting to the emergency room with complaints consistent with cardiac ischemia, but without diagnostic electrocardiography (ECG) or enzymes.

  9. The test may be considered medically necessary in patients status post revascularization procedures who present with recurrent symptoms not clearly identifiable as ischemic.

Limitations:

  1. These tests are never covered for screening, i.e., in the absence of signs, symptoms or disease.

  2. These tests will be considered not medically necessary if the anticipated results are not expected to provide new, additional information to that already previously obtained from other tests (such as stress myocardial perfusion images or cardiac ultrasound). New or additional information should facilitate the management decision, not merely add a new layer of testing.

  3. These tests will be considered not medically necessary if it is anticipated that the patient would require invasive cardiac angiography for further diagnosis or for therapeutic intervention. (e.g., angina decubitus, unstable angina, Prinzmetal angina, etc.)

  4. These tests may be denied, on post-pay review, as not medically necessary when used for cardiac evaluation if there were pre-test knowledge of sufficiently extensive calcification of the suspect coronary segment that would diminish the interpretive value.

  5. The administration of beta blockers and the monitoring of the patient during MDCT/CCTA by a physician experienced in the use of cardiovascular drugs is included as part of the test and is not a separately payable service.

  6. All studies must be ordered by the physician/qualified non-physician practitioner treating the patient and who will use the results of the test in the management of the patient.

  7. CCTA must be performed under the direct supervision of a physician.

  8. This LCD does not address electron beam tomography (EBT) technology or Ultrafast CT for coronary artery examination. There is no extension of coverage of EBT based on this policy.

  9. Quantitative calcium scoring is not a covered service and will be denied as not medically necessary. Calcium scoring reported in isolation is considered a screening service. When performed in association with CT angiography, there is neither separate nor additional included reimbursement for the calcium scoring.

  10. Acceptable Levels of Competence for Performance and Interpretation: Providers submitting claims for these tests must demonstrate proficiency and training in performing the tests according to the following standards:

The acceptable levels of competence, as defined by the American College of Cardiology (ACC)/American Heart Association (AHA) Clinical Competence Statement on Cardiac Imaging with Computed Tomography and Magnetic Resonance (2005) and the American College of Radiology (ACR) Clinical Statement on Noninvasive Cardiac Imaging (2005), are outlined as follows:



For the technical portion, a recommended level of competence is fulfilled when the image acquisition is obtained under all of the following conditions:

  1.  The service is performed by a radiology technologist who is credentialed by a nationally recognized credentialing body (American Registry of Radiologic Technologists or equivalent) and meets state licensure requirements where applicable.
  2. If intravenous beta blockers or nitrates are to be given prior to a CT coronary angiogram, the test must be under the direct supervision of a physician (familiar with the administration of cardiac medications), who should be available to respond to medical emergencies. It is also strongly recommended that the physician be ACLS certified.
  3. When contrast studies are performed, the physician must provide direct supervision and the radiologic technologist or registered nurse administering the contrast must have appropriate training on the use and administration of contrast media.


For the professional portion, a recommended level of competence is fulfilled when the interpretation is performed by a physician meeting the following requirements:

  1.  The physician has appropriate additional training in coronary CTA and cardiac CT imaging equivalent to the guidelines set forth by the ACC or ACR (for example: the ACCF/AHA Clinical Competence Statement on Cardiac Imaging with Computed Tomography and Magnetic Resonance (2005) and the ACR Clinical Statement on Noninvasive Cardiac Imaging (2005)), or
  2. The physician has appropriate medical staff privileges to interpret CT coronary angiograms at a hospital that participates in the Medicare program, and is actively training in cardiac CT (as in paragraph a). A grace period of 24 months will be allowed to acquire the necessary training.
Summary of Evidence

N/A
Analysis of Evidence (Rationale for Determination)

N/A

Proposed Process Information

Synopsis of Changes
Changes Fields Changed
N/A
Associated Information
Sources of Information
Bibliography
Open Meetings
Meeting Date Meeting States Meeting Information
N/A
Contractor Advisory Committee (CAC) Meetings
Meeting Date Meeting States Meeting Information
N/A
MAC Meeting Information URLs
N/A
Proposed LCD Posting Date
Comment Period Start Date
Comment Period End Date
Reason for Proposed LCD
Requestor Information
This request was MAC initiated.
Requestor Name Requestor Letter
N/A
Contact for Comments on Proposed LCD

Coding Information

Bill Type Codes

Code Description
N/A

Revenue Codes

Code Description
N/A

CPT/HCPCS Codes

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Group 1

Group 1 Paragraph

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 Group 1 Codes

N/A

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ICD-10-CM Codes that Support Medical Necessity

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Group 1

Group 1 Paragraph:

N/A

 Group 1 Codes:

N/A

N/A

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

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Group 1

Group 1 Paragraph:

N/A

 Group 1 Codes:

N/A

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Additional ICD-10 Information

General Information

Associated Information
N/A
Sources of Information

This bibliography presents those sources that were obtained during the development of this policy. National Government Services is not responsible for the continuing viability of Web site addresses listed below.

  • Achenbach S, Giesler T, Ropers D, et al. Detection of coronary artery stenoses by contrast-enhanced, retrospectively electrocardiographically-gated, multislice spiral computed tomograhy. Circulation Journal [serial on line]. May 2001.
  • ACR practice guideline for the performance of computed tomography (CT) for the detection of pulmonary embolism in adults. ACR Practice Guideline CT Pulmonary Embolism.2000;8:189-192. Revised 2005;27. Effective 10/01/2005.
  • ACR practice guideline for the performance and interpretation of CT Angiography (CTA). ACR Practice Guideline CT Angiography. 2005;30:271-274. Amended 2006;17,35. Effective 10/01/05.
  • Budoff MJ, Achenbach S, Duerinckx A, et al. Clinical utility of computed tomography and magnetic resonance techniques for noninvasive coronary angiography. The American Journal of Cardiology [serial on line]. November 2003;42.
  • Budoff MJ, Achenbach S, Blumenthal, J, et al. Assessment of coronary artery disease by cardiac computed tomography: a scientific statement from the American Heart Association Committee on cardiovascular imaging and intervention, council on cardiovascular radiology and intervention, and Committee on Cardiac Imaging, Council on Clinical Cardiology. Circulation. October 2006;114;1761-1791.
  • Budoff MJ, Cohen MC, Garcia MJ, et al. ACCF/AHA clinical competence statement on cardiac imaging with computed tomography and magnetic resonance: a report of the American College of Cardiology Foundation/American Heart Association/American College of Physicians Task Force on clinical competence and training (ACC/AHA Committee on CV Tomography). J Am Coll Cardiol. 2005;46:388–402.
  • Chiles C, Carr JJ. Vascular diseases of the thorax: evaluation with multidetector CT. Radiologic Clinics of North America [serial on line]. May 2005;43;3.
  • de Feyter PJ, van Pelt N. Spiral computed tomography coronary angiography: a new diagnostic tool developing its role in clinical cardiology, editorial. Journal of the American College of Cardiology. 2007;49;872-874.
  • Ehara M, Kawai M, Surmely JF, et al. Diagnostic accuracy of coronary in-stent restenosis using 64-slice computed tomography. Journal of the American College of Cardiology. 2007;49:951-959.
  • Gaspar T, Halon DA, Lewis BS, et al. Diagnosis of coronary in-stent restenosis with multidetector row spiral computed tomography. Journal of the American College of Cardiology. 2005;46:1573-1579.
  • Goldstein JA, Gallagher MJ, O’Neill WW, et al. A randomized controlled trial of multislice coronary computed tomography for evaluation of acute chest pain. Journal of the American College of Cardiology. 2007;49:863-871.
  • Hausleiter J, Meyer T, Hadmitzky M, et al. Prevalence of noncalcified plaques by 64-slice computed tomography in patients with an immediate risk for significant coronary artery disease. Journal of the American College of Cardiology. 2006;48:312-318.
  • Hendel RC, Patel MR, Kramer CM, et al. ACCF/ACR/SCMR/ASNC/NASCI/SCAI/SIR Appropriateness criteria for cardiac computed tomography and cardiac magnetic resonance imaging. Journal of the American College of Cardiology. 2006;48:1475-1497.
  • Hoffman U, Moselewski F, Cury RC, et al. Predictive value of 16-slice multidetector spiral computed tomography to detect significant obstructive coronary disease in patients at high risk for coronary artery disease. Patient- Versus Segment-Based Analysis. Circulation. 2004;110:2638-2643.
  • Jongbloed MRM, Lamb HJ, Bax JJ, et al. Noninvasive visualization of the cardiac venous system using multislice computed tomography. Journal of the American College of Cardiology. 2005;45:749-753.
  • Kopp AF, Schroeder S, Kuettner A, et al. Non-invasive coronary angiography with high resolution multidetector-row computed tomography. The European Society of Cardiology. Elsevier Science Ltd. European Heart Journal. 2002;23:1714-1725.
  • Kuettner A, Beck T, Drosch T, et al. Diagnostic accuracy of noninvasive coronary imaging using 16-detector slice spiral computed tomography with 188ms temporal resolution. Journal of the American College of Cardiology. 2005;45:123-127.
  • Lardo AC, Cordeiro MA, Silva C, et al. Contrast-enhanced multidetector computed tomography viability imaging after myocardial infarction. Characterization of myocyte death, microvascular obstruction, and chronic scar. Circulation. 2006;113:394-404.
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  • Leber AW, Kenz A, von Ziegler F, et al. Quantification of obstructive and nonobstructive coronary lesions by 64-slice computed tomography. Journal of the American College of Cardiology. 2005;46:147-154.
  • Lewis B, Halon D. Integrating multidetector computed tomography into clinical practice. Editorial. Journal of the American College of Cardiology. 2007;49:960-962.
  • Matchar DB, Mark DB, Patel MR, et al. Technology assessment: non-invasive imaging for coronary artery disease. AHRQ Technology Assessment Program. October 3, 2006.
  • Meyer TS, Martinoff S, Hadamitzky M, et al. Improved noninvasive assessment of coronary artery bypass grafts with 64-slice computed tomographic angiography in an unselected patient population. Journal of the American College of Cardiology. 2007;49:946-950.
  • Mollet NR, Cademartiri F, van Mieghem CA, et al. High-resolution spiral computed tomography coronary angiography in patients referred for diagnostic convential coronary angiography. Circulation. 2005;112:2318-2323.
  • Mollet NR, Cademartiri F, Krestin GP, et al. Improved diagnostic accuracy with 16-row multi-slice computed tomography coronary angiography. Journal of the American College of Cardiology. 2005;45:128-132.
  • Narevic E, Schoenbert NE. Lay explanations for Kentucky's "Coronary Valley". J Community Health. 2002 Feb;27(1):53-62.
  • Moussa I, Jones M, Kereiakes DJ, et al. Stone Cardiovascular Research Foundation, Lenox Hill Heart & Vascular Institute of New York. Does culprit lesion calcification affect the performance of the Paclitaxel-Eluting Stent? A TAXUS-IV Substudy. Am J Cardiol. 2004;94(suppl 6A):66E.
  • Pijls NH, van Schaardenburgh P. Percutaneous coronary intervention of functionally nonsignificant stenosis: 5-year follow-up of the DEFER Study. Am J Cardiol. 2007;49(21):2105-11.
  • Raff GL, Gallagher MJ, O’Neill WW, et al. Diagnostic accuracy of noninvasive coronary angiography using 64-slice spiral computed tomography. Journal of the American College of Cardiology. 2005;46:552-557.
  • Raman SV, Shah M, McCarthy B, et al. Multi-detector row cardiac computed tomography accurately quantifies right and left ventricular size and function compared with cardiac magnetic resonance. American Heart Journal. 2006;151;3:736-744.
  • Redberg RF. Evidence, appropriateness, and technology assessment in cardiology: A case study of computed tomography. Health Affairs. 2007;27;86-95. 10.1377/hlthaff.26.1.86.
  • Romeo G, Houyel L, Angel CY, et al. Coronary stenosis detection by 16-slice computed tomography in heart transplant patients. Journal of the American College of Cardiology 2005;45:1826-1831.
  • Ropers D, Baum U, Pohle K, et al. Detection of coronary artery stenoses with thin-slice multi-detector row spiral computed tomography and multiplanar reconstruction. Circulation Journal [serial on line]. February 2003.
  • Ropers D, Rixe J. Usefulness of multidetector row spiral computed tomography with 64- x 0.6-mm collimation and 330-ms rotation for the noninvasive detection of significant coronary artery stenoses. Am J Cardiol. 2006 Feb 1;97(3):343-8.
  • Rubinshtein R, Halon D, Gaspar T, et al. Usefulness of 64-slice cardiac computed tomographic angiography for diagnosing acute coronary syndromes and predicting clinical outcome in emergency department patients with chest pain of uncertain origin. Circulation. 2007;115;1762-1768.
  • Sato U, Matsumoto N, Kato M, et al. Noninvasive assessment of coronary artery disease by multislice spiral computed tomography using a new retrospectively ECG-gated image reconstruction technique – comparison with angiopgraphic results. Circulation Journal, [serial on line]. May 2003;67.
  • Schindler TH, Magosaki N, Jeserich M, et al. 3D assessment of myocardial perfusion parameter combined with 3D reconstructed coronary artery tree from digital coronary angiograms. International Journal of Cardiac Imaging. 2000;16:1-12.
  • Schoepf UJ, Costello P. CT angiography for diagnosis of pulmonary embolism: state of the art. Radiology. [serial on line]. 1148/radiol.2302021489. 2004:329-337.
  • Schroeder S, Kopp AF, Baumbach A, et al. Non-invasive characterization of coronary lesion morphology by multislice computed tomography: a promising new technology for risk stratification of patient with coronary artery disease. @ http://heart.bmjjournals.com/cgi/contebt/full/85/5/576a
  • Schuijf JD, Pundziute G, Jukema JW, et al. Diagnostic accuracy of 64-slice multislice computed tomography in the noninvasive evaluation of significant coronary artery disease. American Journal of Cardiology. 2006;98:145-148.
  • Schuijf JD, Bax JJ, Salm LP, et al. Noninvasive coronary imaging and assessment of left ventricular function using 16-slice computed tomography. American Journal of Cardiology. 2005;95:571-574.
  • Shapiro M, Butler J. Analytic approaches to establish the diagnostic accuracy of coronary computed tomography angiography as a tool for clinical decision making. Am J Cardiol. 2007;Apr 15;99(8):1122-7.
  • Tobis J. A non-biased assessment of the usefulness of computed tomographic angiography. Am J Cardiol. 2007;Apr 15;99(8):1165.
  • Vliegenthart R, Oudkerk M, Hofman A, et al. Coronary calcification improves cardiovascular risk prediction in the elderly. Circulation. 2005;112:572-577.
  • White RD, Setser RM. Integrated approaches to evaluating coronary artery disease and ischemic heart disease. The American Journal of Cardiology [serial on line]. November 2002;90.
  • Model Local Coverage Determination (LCD) Work Group for Cardiac Computed Tomography (CCT) and Computed Tomography Coronary Angiography (CTCA), comprising of the American College of Cardiology (ACC), Carrier Advisory Committee (CAC), American College of Radiology (ACR), American Society of Nuclear Cardiology (ASNC), North American Society for Cardiac Imaging (NASCI) Society of Cardiac Angiography and Intervention (SCAI) and Society of Cardiovascular CT (SCCT), which had the following sources:
    • American College of Cardiology Foundation (ACCF)/American Heart Association (AHA) clinical competence statement on cardiac imaging with computed tomography and magnetic resonance. JACC. 2005;46;2;383-402.
    • American College of Radiology Clinical Statement on Noninvasive Cardiac Imaging. Radiology. 2005;235:723–727.
    • Burgstahler C, Trabold T, Kuettner A, et al. Visualization of pulmonary vein stenosis after radio frequency ablation using multi-slice computed tomography: initial clinical experience in 33 patients. Int J Cardiol. 2005;102(2):287-91.
    • Cademartiri F, Mollet NR, van der Lugt A, et al. Intravenous contrast material administration at helical 16-detector row CT coronary angiography: effect of iodine concentration on vascular attenuation. Radiology. 2005;236:661-665.
    • Cademartiri F, Nieman K, van der Lugt A, et al. Intravenous contrast material administration at 16-detector row helical CT coronary angiography: test bolus versus bolus-tracking technique. Radiology. 2004;233:817-823.
    • Chiurlia E, Menozzi M, Ratti C, et al. Follow-up of coronary artery bypass graft patency by multislice computed tomography. Am J Cardio. 2005;95(9):1094-1097.
    • Contractor S, Maldjian PD, Sharma VK, et al. Role of helical CT in detecting right ventricular dysfunction secondary to acute pulmonary embolism. J Comput Assist Tomogr. 2002;26(4):587-91.
    • Cronin P, Sneider M, Kazerooni EA, et al. Imaging of the left atrium and pulmonary veins in planning for radiofrequency ablation for atrial fibrillation: a how to guide. American Journal of Roentgenology. 2004;183:767-778.
    • Cui W, Anno H, Kondo T, et al. Right ventricular volume measurement with singleplane Simpson's method based on a new half-circle model. Int J Cardiol. 2004;94(2-3):289-92.
    • Datta J, White CS, Gilkeson RC, et al. Anomalous coronary arteries in adults: depiction at multi-detector row CT angiography. Radiology. 2005;235:812-818.
    • Deibler AR, Kuzo RS, Vohringer M, et al. Imaging of congenital coronary anomalies with multislice computed tomography. Mayo Clin Proc. 2004;79:1017-1023.
    • Desjardins B, Kazerooni EA. ECG-gated cardiac CT. American Journal of Roentgenology, 2004;182:993-1010.
    • Funabashi N, Kobayashi Y, Kudo M, et al. New method of measuring coronary diameter by electron-beam computed tomographic angiography using adjusted thresholds determined by calibration with aortic opacity. Circ J. 2004;68:769-777.
    • Funabashi N, Kobayashi Y, Perlroth M, et al. Coronary Artery: Quantitative Evaluation of Normal Diameter Determined with Electron-Beam CT Compared with Cine Coronary Angiography Initial Experience. Radiology. 2003;226:263-271.
    • Gerber BL, Coche E, Pasquet A, et al. Coronary artery stenosis: direct comparison of four-section multi-detector row CT and 3D navigator MR imaging for detection-initial results. Radiology. 2005.
    • Herzog C, Dogan S, Diebold T, et al. Multi-detector row CT versus coronary angiography: preoperative evaluation before totally endoscopic coronary artery bypass grafting. Radiology. 2003;229:200-208.
    • Hoffmann MH, Shi H, Schmitz BL, et al. Noninvasive coronary angiography with multislice computed tomography. JAMA. 2005;293:2471-2478.
    • Hofmann LK, Zou KH, Costello P, et al. Electrocardiographically gated 16- section CT of the thorax: cardiac motion suppression. Radiology. 2004;233:927-933.
    • Hong C, Chrysant GS, Woodard PK, et al. Coronary artery stent patency assessed with in-stent contrast enhancement measured at multi-detector row CT angiography: initial experience. Radiology. 2004;233:286-291.
    • Hundt W, Siebert K, Wintersperger BJ, et al. Assessment of global left ventricular function: comparison of cardiac multidetector-row computed tomography with angiocardiography. J Comput Assist Tomogr. 2005;29:373-381.
    • Jaber W, White RD, Kuzmiak SK, et al. Comparison of ability to identify left atrial thrombus by three-dimensional tomography versus transesophageal echocardiography in patients with atrial fibrillation. Am J Cardiol. 2004;93(4):486-9.
    • Jongbloed MR, Bax JJ, Lamb HJ, et al. Multislice computed tomography versus intracardiac echocardiography to evaluate the pulmonary veins before radiofrequency catheter ablation of atrial fibrillation: a head-to-head comparison. J Am Coll Cardiol. 2005;45(3):343-50.
    • Jongbloed MR, Bax JJ, Lamb HJ, et al. Noninvasive visualization of the cardiac venous system using multislice computed tomography. J Am Coll Cardiol. 2005;45(5):749-53.
    • Kaklikkaya I, Yeginoglu G. Damage to coronary arteries during mitral valve surgery. Heart Surg Forum 2003; 6:E138-42.
    • Khouzam R, Marshal T, Lowell D, et al. Left coronary artery originating from right sinus of Valsalva with diagnosis confirmed by CTa case report. Angiology. 2003;54:499-502.
    • Kimura F, Saki F, Sakomura Y, et al. Helical CT features of arrhythmogenic right ventricular cardiomyopathy. Radiographics. 2002;22(5):1111-24. Review.
    • Kimura S, Kakuta T, Kuboyama O, et all. Multislice computed tomography for risk stratification in patients with suspected non ST segment elevation acute coronary syndrome. Circulation. 2004;110(Suppl III):abstract 2449.
    • Kuettner A, Trabold T, Schroeder S, et al. Noninvasive detection of coronary lesions using 16-detector multislice spiral computed tomography technology: initial clinical results. J Am Coll Cardiol. 2004;44:1230-1237.
    • Lacomis JM, Wigginton, W, Fuhrman C, et al. Multi-detector row CT of the left atrium and pulmonary veins before radio-frequency catheter ablation for atrial fibrillation. Radiographics. 2003;23 Spec No:S35-48;discussion S48-50. Review.
    • Langheinrich AC, Bohle RM, Greschus S, et al. Atherosclerotic lesions at micro CT: feasibility for analysis of coronary artery wall in autopsy specimens. Radiology. 2004;231:675-681.
    • Lau GT, Ridley JT, Schieb MC, et al. Coronary artery stenoses: detection with calcium scoring, CT angiography, and both methods combined. Radiology,. 2005;235:415-422.
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    • Lemola K, Mueller G, Desjardins B, et al. Topographic analysis of the coronary sinus and major cardiac veins by computed tomography. Heart Rhythm. 2005;2:694-699.
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    • Lessick J, Kummar C, Beyar R, et al. Anomalous origin of a posterior descending artery from the right pulmonary artery: report of a rare case diagnosed by multidetector computed tomography angiography. J Comput Assist Tomogr. 2004;28:857-859.
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    • Lu B, Zhuang N, Mao SS, et al. Baseline heart rate-adjusted electrocardiographic triggering for coronary artery electron-beam CT angiography. Radiology. 2004;233:590-595.
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    • Martuscelli E, Romagnoli A, D’Eliseo A, et al. Evaluation of venous and arterial conduit patency by 16-slice spiral computed tomography. Circulation. 2004;110(20):3234-2328.
    • Nanthakumar K, Mountz JM, Plumb VJ, et al. Functional assessment of pulmonary vein stenosis using radionuclide ventilation/perfusion imaging. Chest. 2004 Desjardins B, ;126(2):645-51.
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Sources added for FFR, revision effective 01/01/2018:

  •  Benton SM, Tesche C, De Cecco CN, Duguay TM, Schoepf UJ, Bayer RR. Noninvasive derivation of fractional flow reserve from coronary computed tomographic angiography: a review. J Thorac Imaging. 2018;33(2):88-96.

  • Cohen MC, Garcia MJ, Hodgson JM, et al.ACCF/AHA Clinical competence statement on cardiac imaging with computed tomography and magnetic resonance. 2005;46(2). Focused Update: J Amer Coll Cardiol. 2009;54(25):2463-4.

  • De Bruyne B, Fearon WF, Pijls NH, et al. Fractional flow reserve-guided PCI for stable coronary artery disease. N Engl J Med. 2014;371(13):1208-1217.

  • Koo BK, Erglis A, Doh JH, et al. Diagnosis of ischemia-causing coronary stenoses by noninvasive fractional flow reserve computed from coronary computed tomographic angiograms. Results from the prospective multicenter DISCOVER-FLOW (Diagnosis of Ischemia-Causing Stenoses Obtained Via Noninvasive Fractional Flow Reserve) study. J Am Coll Cardiol. 2011;58(19):1989-1997.

  • Mark DB, Berman DS, Budoff MJ, et al. ACCF/ACR/AHA/NASCI/SAIP/SCAI/SCCT 2010 expert consensus document on coronary computed tomographic angiography: a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents. Catheter Cardiovasc Interv. 2010;76(2):E1-42.

  • Norgaard BL, Hjort J, Gaur S, et al, Clinical use of coronary CTA-derived FFR for decision making in stable CAD. JACC. 2016.

  • Norgaard BL, Leipsic J, Gaur S, et al. Diagnostic performance of noninvasive fractional flow reserve derived from coronary computed tomography angiography in suspected coronary artery disease: the NXT trial (Analysis of Coronary Blood Flow Using CT Angiography: Next Steps). J Am Coll Cardiol. 2014;63(12):1145-1155.

  • Patel MR, Calhoon JH, Dehmer GJ, et al. ACC/AATS/AHA/ASE/ASNC/SCAI/SCCT/STS 2017 Appropriate use criteria for coronary revascularization in patient with stable ischemic heart disease. JACC.2017. 02(001).

  • Rybicki FJ, Udelson JE, Peacock WF. et al.  ACR/ACC/AHA/AATS/ACEP/ASNC/NASCI/SAEM/SCCT/SCMR/SCPC/SNMMI/STR/STS Appropriate utilization of cardiovascular imaging in emergency department patients with chest pain. 2015;67(7).
Bibliography

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Revision History Information

Revision History Date Revision History Number Revision History Explanation Reasons for Change
04/01/2022 R6

The LCD was returned for comment from 6/03/2021 through 7/17/2021, to remove references to fractional flow reserve (FFR) services from the LCD. FFR provisions were moved to a new LCD, L39075, effective 04/01/2022.

Based on a comment received, the requirement for a certified registered nurse to supervise the use of intravenous beta blockers or nitrates given prior to a CT coronary angiogram was removed from limitations for the technical portion of the CCTA test.
  • Creation of Uniform LCDs With Other MAC Jurisdiction
10/01/2019 R5

This LCD was converted to the new "no-codes" format. There has been no change in coverage with this LCD revision.
  • Revisions Due To Code Removal
08/01/2019 R4

Consistent with Change Request 10901, all coding information, National coverage provisions, and Associated Information (Documentation Requirements, Utilization Guidelines) have been removed from the LCD and placed in the related Billing and Coding Article, A56737. There has been no change in coverage with this LCD revision.
  • Provider Education/Guidance
01/01/2018 R3

LCD revised to add coverage for CPT codes 0501T-0504T (Fractional Flow Reserve) effective for dates of service on or after January 1, 2018. Sources reviewed for this coverage were added to Sources of Information.
  • Provider Education/Guidance
  • Request for Coverage by a Practitioner (Part B)
10/01/2016 R2 LCD revised for annual ICD-10 updates for 2017 with the following changes:
ICD-10 codes Q25.2 and Q25.4 have been deleted.
  • Revisions Due To ICD-10-CM Code Changes
10/01/2015 R1 08/20/2015 - For the following Revenue Codes the description changed:
0321 descriptor was changed
  • Provider Education/Guidance
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