Cardiac Computed Tomography (CCT)/Coronary Computed Tomographic Angiography (CCTA) 6.01.34

By May 15, 2026: Billing and clinical teams must implement this new policy immediately upon effective date. REQUIREMENTS: (1) Providers 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; (2) Billing team must establish prior authorization procedures to verify medical necessity against these criteria before claim submission; (3) Implement 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; (4) Update claim review procedures to recognize FFR-CT as appropriate for uncertain physiologic significance on prior CCTA (Section II); (5) Configure 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; (6) Establish denial prevention rules rejecting plaque quantification claims within 30 days of MI or for unstable syndromes (Section IV); (7) Document all CCTA requests with specific clinical indicators from the policy to support medical necessity and prevent denials; (8) Train 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). Claims submitted without alignment to these specific criteria will be subject to denial.