Medicare AdvantageCoverageMedium impact
Coronary CT Angiography, Fractional Flow Reserve with CT and Adjunctive Testing - Medicare Advantage (Revised)
Humana·Cardiology, Internal Medicine·Medicare Advantage
We identified it
Jun 30, 2026
Summary
This is a new Medicare Advantage policy establishing coverage guidelines for Coronary CT Angiography (CCTA), Fractional Flow Reserve with CT (FFR-CT), and adjunctive cardiac imaging tests. The policy defines covered procedures including coronary artery calcium scoring, 3D predictive modeling, and cardiac acoustic waveform recording as alternatives to invasive cardiac angiography for coronary artery disease diagnosis.
Action Required
Billing team must immediately: 1) Obtain and review the complete policy document from the source URL (https://dctm.humana.com/Mentor/Web/v.aspx?objectID=090009298a5698a2) to extract specific CPT and HCPCS codes covered under this revised policy; 2) Confirm effective date and any prior authorization requirements; 3) Update billing system rules and fee schedules once codes are identified; 4) Notify cardiology providers of coverage changes to CCTA and FFR-CT procedures; 5) Train billing staff on proper coding and documentation requirements for these cardiac imaging services. Do NOT bill any cardiac CT procedures under this revised policy until specific covered codes and effective date are confirmed from the complete policy document, as only a summary was provided.