Traditional MedicareCoverageHigh impact
Artificial Intelligence Enabled CT Based Quantitative Coronary Topography (AI-QCT)/Coronary Plaque Analysis (AI-CPA)
Medicare/CMS - LCD·Cardiology, Radiology·Local Coverage Determination
Effective date
Apr 1, 2026
We identified it
Jul 28, 2026
Summary
Wellpoint Federal (Part A and Part B MAC) has issued a new Local Coverage Determination (LCD L39863) effective April 1, 2026, establishing coverage policies for AI-enabled CT-based Quantitative Coronary Topography (AI-QCT) and Coronary Plaque Analysis (AI-CPA) procedures. Billing teams must immediately obtain and review the full policy text to identify covered codes, prior authorization requirements, and documentation mandates before claims processing begins.
Action Required
By March 15, 2026: (1) Billing team must access the full LCD L39863 policy text at https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdid=39863&ver=10 to extract all covered CPT and HCPCS codes for AI-QCT and AI-CPA services. (2) Update billing software with identified codes and any required prior authorization workflows. (3) Cardiology providers and front desk staff must be trained on new documentation requirements and prior auth processes. (4) Add AI-QCT/AI-CPA coverage verification to encounter templates in EMR. (5) Configure billing system to flag claims for Wellpoint Federal Part A/Part B patients requiring this service. Claims submitted without compliance to this LCD after April 1, 2026 will be subject to denial by Wellpoint Federal.