IMAGE ANALYSIS INC.
CORONARY CALCIUM REIMBURSEMENT
CORONARY CALCIUM COVERAGE
Below you will find information relating to coding, coverage, and payment for diagnostic cardiac computed tomography (CT) and computed tomographic angiography (CCTA). While this advisory focuses on Medicare program policies, these policies may also be applicable to selected private payers throughout the country.


AMERICAN MEDICAL ASSOCIATION

The American Medical Association (AMA) developed and maintains Current Procedural Terminology (CPT) codes to consistently identify diagnostic imaging procedures. Medicare relies on these codes to determine reimbursement. The codes relating to CT coronary calcium scoring fall under the designation of Category III Codes, denoted by four digits followed by an alphabetic character. For more information on Category III codes and their use, refer to the coding guidelines that accompany the relevant section of CPT® 2008. The guidelines are also posted on the AMA website. To be taken to the AMA website click the link below.

MEDICARE

Third party coverage policies for diagnostic cardiac CT and Calcium Scoring vary by payer and locality. Medicare's National Coverage Determination (NCD) for computed tomography (CT) does not specifically address coverage of cardiac CT or CCTA. The NCD states that CT scans may be covered as diagnostic services if reasonable and necessary, and if performed on an FDA-approved model of CT equipment. The local Medicare contractors have discretion to determine the specific circumstances under which a CT scan is covered. The NCD is described in the Internet Manual for Medicare National Coverage Determinations. Click the link below and scroll down 220.1 to read the NCD.

Manual for Medicare National Coverage Determinations

Some local Medicare contractors have developed Local Coverage Determinations (LCDs) that address cardiac CT procedures. Importantly, these LCDs may restrict or deny coverage for such procedures. A directory of local Medicare contractors can be accessed below.

Local Medicare Contractors


To access the LCDs, refer to the individual contractor's website or click the link below:

Local Coverage Determinations (LCDs)



AMERICAN COLLEGE OF RADIOLOGY

The American College of Radiology (ACR) has provided guidance in the utilization of CPT Category III codes. According to the ACR, each patient procedure is described by only one of the primary codes. Therefore, a code 0144T is not to be reported in conjunction with any of the other heart CT codes, as it is the only code in which the sole purpose of the imaging is for quantitative evaluation of coronary calcium.

Per the ACR and AMA, 2D and 3D rendering images are considered in the cardiac CT and CCTA codes; therefore, a separate 3D rendering code (i.e., CPT codes 76376 or 76377) should not be reported with the cardiac CT and CCTA codes. The AMA provides a list of codes which should not be reported in conjunction with 3D rendering codes and are included on a list in CPT 2008.

When submitting claims to Medicare, procedural CPT codes are reported with diagnosis codes describing the patient's documented medical conditions. These diagnoses are reported using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). Just because a code exists, does not necessarily mean it is covered and payable. Also, some private payers rely on Medicare determinations, while others may consider alternative information and make independent decisions. Therefore, it is important to consult an authoritative coding resource to determine and submit appropriate codes, and with the individual private payer regarding their coverage policies. For more information on cardiac CT and CCTA coding, click on the link for the ACR website below: