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Cardiac Computed Tomography (CCT)/Coronary Computed Tomographic Angiography (CCTA) 6.01.34
Act
by May 15, 2026
Effective date
May 15, 2026
Identified
Jul 16, 2026
Summary
Excellus BlueCross BlueShield has issued a comprehensive new policy (6.01.34) effective May 15, 2026, establishing detailed medical necessity criteria for Cardiac Computed Tomography (CCT) and Coronary Computed Tomographic Angiography (CCTA) procedures. The policy expands covered indications across multiple cardiac scenarios including chest pain evaluation, anomalous coronary artery assessment, pre-transplant evaluation, and structural heart disease assessment, while also establishing new requirements for FFR-CT and coronary plaque quantification.
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What to do
by May 15, 2026 · 10 steps
01Billing and clinical teams must implement this new policy immediately upon effective date.
02Providers must update order entry systems and clinical documentation templates to align with the 14 specific covered indications (A-Q) for CCTA outlined in Section I of the policy.
03Billing team must establish prior authorization procedures to verify medical necessity against these criteria before claim submission.
04Implement denial prevention by training front desk and clinical staff on the expanded covered scenarios, particularly new provisions for patients under 40 with suspected anomalous coronary arteries and pre-transplant cardiac evaluations.
05Update claim review procedures to recognize FFR-CT as appropriate for uncertain physiologic significance on prior CCTA (Section II).
06Configure billing system to require specific clinical documentation for coronary plaque quantification claims to meet the 'intermediate risk' or 'CAD-RADS 1-3' criteria in Section III.
07Establish denial prevention rules rejecting plaque quantification claims within 30 days of MI or for unstable syndromes (Section IV).
08Document all CCTA requests with specific clinical indicators from the policy to support medical necessity and prevent denials.
09Train providers to understand distinction between covered plaque analysis scenarios (intermediate findings) versus non-covered scenarios (normal, high-grade stenosis, or CAD-RADS 0, 4, 5).
10Claims submitted without alignment to these specific criteria will be subject to denial.
Original notice
Cardiac Computed Tomography (CCT)/Coronary Computed Tomographic Angiography (CCTA) 6.01.34
excellusbcbs.com · Always check the source before changing claims.
Related changes
See all Excellus BlueCross BlueShield changes →Cardiac Computed Tomography (CCT)/Coronary Computed Tomographic Angiography (CCTA) - (Effective Date - 2026-10-15) 6.01.34MediumEffective Oct 15, 2026 · Radiology (x-rays) & ImagingCardiac Computed Tomography (CCT)/Coronary Computed Tomographic Angiography (CCTA) 6.01.34MediumEffective May 15, 2026 · Radiology (x-rays) & ImagingBrowse every Excellus BlueCross BlueShield change in the policy list