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AetnaCommercial · Coverage · Radiology · Cardiology, RadiologyMedium impact

Cardiac Computed Tomography (CT), Coronary CT Angiography, Calcium Scoring and CT Fractional Flow Reserve (CPB 0228, reviewed 2026-07-21)

Effective date
Not stated in the notice
Identified
Aug 15, 2026

Summary

Aetna considers cardiac CT and coronary CT angiography (CCTA) medically necessary when criteria are met, including CCTA on a 64-slice or greater scanner to rule out obstructive coronary stenosis in symptomatic persons with low or intermediate pre-test probability of coronary artery disease. Calcium scoring is covered for asymptomatic adults aged 40 to 75 with a borderline or intermediate (5% to 19.9%) 10-year risk of cardiac events who are not on a statin, have no history of diabetes, and have no family history of premature CAD. Aetna considers CCTA experimental, investigational or unproven for persons with a BMI greater than 40 (except when 3rd generation dual-source CT at 120 kV is used), for screening asymptomatic persons, and for persons with extensive coronary calcification or a prior Agatston score greater than 1000, and repeat calcium scoring is covered only when the most recent scan was zero, at least 5 years ago, and discovery of coronary calcium would change management.

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What to do

Action · 6 steps
01Billing team: Bill CCTA (CPT 75574) only for the covered indications, and keep documentation showing the criteria are met, including the pre-test probability from Framingham risk scoring, Pooled Cohort Equations or ACC criteria.
02Do not schedule or bill CCTA for persons with a BMI greater than 40 (except with 3rd generation dual-source CT at 120 kV), inability to reach a heart rate under 80 beats per minute despite beta blocker, atrial fibrillation (except rate-controlled with 3rd generation dual-source CT at 120 kV), extensive coronary calcification or a prior Agatston score greater than 1000, scanners with fewer than 64 slices, or screening of asymptomatic persons, because the policy considers these experimental, investigational or unproven.
03Bill repeat calcium scoring (CPT 75571) only when the most recent scan was zero, was at least 5 years ago, and discovery of coronary calcium would change management.
04Bill CPT 75577 plaque analysis only when the platform is FDA-cleared, the member has acute or stable chest pain with no known CAD, the current CCTA shows intermediate risk, CAD-RADS 1, 2 or 3 (not CAD-RADS 4, 5 or N), and the physical examination and other cardiac testing are negative or inconclusive for acute coronary syndrome.
05Bill CPT 75580 FFR only when the CCTA shows CAD of uncertain functional significance or is non-diagnostic.
06Do not bill CPT 0992T or 0993T (Ca-Ri Heart) or combined CCTA and dynamic CT myocardial perfusion, which the policy lists as not covered.

Codes mentioned

7557175572755737557475577755807047178431S8092I25.10I25.82I20.0R07.1R07.9R93.1Z13.6Z68.41Z91.041T82.855AZ01.810

Original notice

Cardiac Computed Tomography (CT), Coronary CT Angiography, Calcium Scoring and CT Fractional Flow Reserve (CPB 0228, reviewed 2026-07-21)
aetna.com · Always check the source before changing claims.
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Related policy hubs

Aetna policiesCardiologyRadiologyCode 75571Code 75572Code 75573Code 75574Code 75577Code 75580Code 70471Code 78431Code S8092Code I25.10Code I25.82Code I20.0Code R07.1Code R07.9Code R93.1Code Z13.6Code Z68.41Code Z91.041Code T82.855ACode Z01.810

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