CommercialCoverageMedium impact
Computed Tomography (CT) for Coronary Calcium Scoring 6.01.13
Excellus BlueCross BlueShield·Cardiology, Radiology, Family Medicine +1 more·Radiology (x-rays) & Imaging
Effective date
May 15, 2026
We identified it
Jun 20, 2026
Summary
Excellus BlueCross BlueShield updated their CT coronary calcium scoring policy (6.01.13) effective May 15, 2026, establishing strict criteria for coverage including specific age ranges (40-75), LDL levels, ASCVD risk scores, and excluding patients with diabetes, smokers, or family history of premature CAD. The policy also covers calcium scoring for radiation-induced CAD screening and low gradient aortic stenosis evaluation.
Action Required
Before May 15, 2026: Billing team must update prior authorization requirements for CPT 75571 (coronary calcium scoring) to verify all 11 criteria are met for asymptomatic patients including age 40-75, LDL 70-190 mg/dl, ASCVD risk 5.0-19.9%, no diabetes, no smoking, no statin use, and no family history of premature CAD. Update system to prevent billing 75571 with contrast CT codes 75572-75574. Train staff on new radiation-induced CAD and aortic stenosis coverage criteria.