Medicare: Cahaba – Blue Cross and Blue Shield of Alabama (equipment must have 64 slices)
Commerical Payers:
Aetna
equipment must have 64 slices; considered medically necessary for: a) rule out stenosis for persons with low or very low pre-test risk based on Framingham or ACC criteria with any of the following indications: 1) persons with chest pain who cannot have exercise or pharmacologic stress testing; 2) persons with positive stress test; 3) evaluating chest pain in ER when imaging stress test or angiography are being deferred; b) evaluation of asymptomatic persons at low risk who have equivocal exercise or pharm. stress test; c) pre-op for persons undergoing high risk non cardiac surgery where imaging stress or angiography is being deferred; d) pre-op for planning noncoronary cardiac surgery in lieu of cardiac cath; e) detection of coronary anomalies in young persons (<30) with suggestive symptoms. considered experimental for persons with extensive calcification; atrial fib or other significant arrhythmia; inability to image at desired heart rate despite beta blockers; BMI>40, for asymptomatic persons or evaluation of persons at intermediate or high risk
Alabama Blue Cross
after 2/1/07, CTA using a 64 slice scanner or greater is covered for detection of CAD- symptomatic; detection of CAD w/ prior test results; structure and function (morphology, evaluation of intra and extra cardiac structures, evaluation of aortic and pulmonary disease; Contraindications include irregular rhythm, very obese (BMI >40kg/m2), renal insufficiency, heart rate>70bpm refractory to heart rate lowering agents, metallic interference.
Cigna
covers 64 slice or greater as adjunct to other testing for the following indications: 1) detection of CAD in symptomatic (ie chest pain) patients if intermediate pre-angiography probability of CAD and ECG uninterpretable or patient unable to exercise; 2) for detection of CAD in symptomatic patients if patient exhibits intermediate pre-angiography probability of CAD and no ECG changes and serial enzymes negative. Also covered for suspected congenital anomalies of coronary circulation or great vessels, suspected peripheral arterial disease independent of # of slices.
Humana
Coverage is limited to devices with slice thickness of 1 mm or less and at least 40 slices per rotation for the following indications: CTA may be used as an alternative to stress echo or stress radionuclide scan in patients who have an equivocal or suspected inaccurate stress EKG (not covered for patients with typical angina and an abnormal stress EKG or stress imaging test). Covered for suspected congenital abnormalities of coronary circulation, to evaluation of chest pain in the ER, and for the assessment of coronary or pulmonary venous anatomy.
United Healthcare
covered when using machines with 64-slices or greater for the assessment of patients with known or suspected CAD. This includes patients with chest pain syndrome and intermediate pre-angiography probability of CAD when ECG is uninterpretable or patient is unable to exercise; patients with chest pain syndrome and prior uninterpretable or equivocal stress test or patients with acute chest pain and intermediate pre-angiography probability of CAD, no ECG changes and negative serial enzymes. Also covered for assessment of patients with known and suspected coronary anomalies or congenital heart disease. Not covered when using fewer than 64 slice technology or for screening asymptomatic persons or persons at low risk for CAD.
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Medicare: Noridian (equipment have collimation of .625 mm or less and a rotational speed of 375 msec or less OR AT LEAST 64 SLICES)
Commercial Payers:
Aetna
equipment must have 64 slices; considered medically necessary for: a) rule out stenosis for persons with low or very low pre-test risk based on Framingham or ACC criteria with any of the following indications: 1) persons with chest pain who cannot have exercise or pharmacologic stress testing; 2) persons with positive stress test; 3) evaluating chest pain in ER when imaging stress test or angiography are being deferred; b) evaluation of asymptomatic persons at low risk who have equivocal exercise or pharm. stress test; c) pre-op for persons undergoing high risk non cardiac surgery where imaging stress or angiography is being deferred; d) pre-op for planning noncoronary cardiac surgery in lieu of cardiac cath; e) detection of coronary anomalies in young persons (<30) with suggestive symptoms. considered experimental for persons with extensive calcification; atrial fib or other significant arrhythmia; inability to image at desired heart rate despite beta blockers; BMI>40, for asymptomatic persons or evaluation of persons at intermediate or high risk
Cigna
covers 64 slice or greater as adjunct to other testing for the following indications: 1) detection of CAD in symptomatic (ie chest pain) patients if intermediate pre-angiography probability of CAD and ECG uninterpretable or patient unable to exercise; 2) for detection of CAD in symptomatic patients if patient exhibits intermediate pre-angiography probability of CAD and no ECG changes and serial enzymes negative. Also covered for suspected congenital anomalies of coronary circulation or great vessels, suspected peripheral arterial disease independent of # of slices.
United Healthcare
covered when using machines with 64-slices or greater for the assessment of patients with known or suspected CAD. This includes patients with chest pain syndrome and intermediate pre-angiography probability of CAD when ECG is uninterpretable or patient is unable to exercise; patients with chest pain syndrome and prior uninterpretable or equivocal stress test or patients with acute chest pain and intermediate pre-angiography probability of CAD, no ECG changes and negative serial enzymes. Also covered for assessment of patients with known and suspected coronary anomalies or congenital heart disease. Not covered when using fewer than 64 slice technology or for screening asymptomatic persons or persons at low risk for CAD.
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Medicare: Noridian (equipment have collimation of .625 mm or less and a rotational speed of 375 msec or less OR AT LEAST 64 SLICES)
Commerical Payers:
Aetna
Equipment must have 64 slices; considered medically necessary for: a) rule out stenosis for persons with low or very low pre-test risk based on Framingham or ACC criteria with any of the following indications: 1) persons with chest pain who cannot have exercise or pharmacologic stress testing; 2) persons with positive stress test; 3) evaluating chest pain in ER when imaging stress test or angiography are being deferred; b) evaluation of asymptomatic persons at low risk who have equivocal exercise or pharm. stress test; c) pre-op for persons undergoing high risk non cardiac surgery where imaging stress or angiography is being deferred; d) pre-op for planning noncoronary cardiac surgery in lieu of cardiac cath; e) detection of coronary anomalies in young persons (<30) with suggestive symptoms. considered experimental for persons with extensive calcification; atrial fib or other significant arrhythmia; inability to image at desired heart rate despite beta blockers; BMI>40, for asymptomatic persons or evaluation of persons at intermediate or high risk.
Cigna
Covers 64 slice or greater as adjunct to other testing for the following indications: 1) detection of CAD in symptomatic (ie chest pain) patients if intermediate pre-angiography probability of CAD and ECG uninterpretable or patient unable to exercise; 2) for detection of CAD in symptomatic patients if patient exhibits intermediate pre-angiography probability of CAD and no ECG changes and serial enzymes negative. Also covered for suspected congenital anomalies of coronary circulation or great vessels, suspected peripheral arterial disease independent of # of slices.
Humana
Coverage is limited to devices with slice thickness of 1 mm or less and at least 40 slices per rotation for the following indications: CTA may be used as an alternative to stress echo or stress radionuclide scan in patients who have an equivocal or suspected inaccurate stress EKG (not covered for patients with typical angina and an abnormal stress EKG or stress imaging test). Covered for suspected congenital abnormalities of coronary circulation, to evaluation of chest pain in the ER, and for the assessment of coronary or pulmonary venous anatomy.
United Healthcare
Covered when using machines with 64-slices or greater for the assessment of patients with known or suspected CAD. This includes patients with chest pain syndrome and intermediate pre-angiography probability of CAD when ECG is uninterpretable or patient is unable to exercise; patients with chest pain syndrome and prior uninterpretable or equivocal stress test or patients with acute chest pain and intermediate pre-angiography probability of CAD, no ECG changes and negative serial enzymes. Also covered for assessment of patients with known and suspected coronary anomalies or congenital heart disease. Not covered when using fewer than 64 slice technology or for screening.
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Medicare: Noridian (equipment have collimation of .625 mm or less and a rotational speed of 375 msec or less OR AT LEAST 64 SLICES)
Commerical Payers:
Aetna
Equipment must have 64 slices; considered medically necessary for: a) rule out stenosis for persons with low or very low pre-test risk based on Framingham or ACC criteria with any of the following indications: 1) persons with chest pain who cannot have exercise or pharmacologic stress testing; 2) persons with positive stress test; 3) evaluating chest pain in ER when imaging stress test or angiography are being deferred; b) evaluation of asymptomatic persons at low risk who have equivocal exercise or pharm. stress test; c) pre-op for persons undergoing high risk non cardiac surgery where imaging stress or angiography is being deferred; d) pre-op for planning noncoronary cardiac surgery in lieu of cardiac cath; e) detection of coronary anomalies in young persons (<30) with suggestive symptoms. considered experimental for persons with extensive calcification; atrial fib or other significant arrhythmia; inability to image at desired heart rate despite beta blockers; BMI>40, for asymptomatic persons or evaluation of persons at intermediate or high risk.
Cigna
Covers 64 slice or greater as adjunct to other testing for the following indications: 1) detection of CAD in symptomatic (ie chest pain) patients if intermediate pre-angiography probability of CAD and ECG uninterpretable or patient unable to exercise; 2) for detection of CAD in symptomatic patients if patient exhibits intermediate pre-angiography probability of CAD and no ECG changes and serial enzymes negative. Also covered for suspected congenital anomalies of coronary circulation or great vessels, suspected peripheral arterial disease independent of # of slices.
Humana
Coverage is limited to devices with slice thickness of 1 mm or less and at least 40 slices per rotation for the following indications: CTA may be used as an alternative to stress echo or stress radionuclide scan in patients who have an equivocal or suspected inaccurate stress EKG (not covered for patients with typical angina and an abnormal stress EKG or stress imaging test). Covered for suspected congenital abnormalities of coronary circulation, to evaluation of chest pain in the ER, and for the assessment of coronary or pulmonary venous anatomy.
United Healthcare
Covered when using machines with 64-slices or greater for the assessment of patients with known or suspected CAD. This includes patients with chest pain syndrome and intermediate pre-angiography probability of CAD when ECG is uninterpretable or patient is unable to exercise; patients with chest pain syndrome and prior uninterpretable or equivocal stress test or patients with acute chest pain and intermediate pre-angiography probability of CAD, no ECG changes and negative serial enzymes. Also covered for assessment of patients with known and suspected coronary anomalies or congenital heart disease. Not covered when using fewer than 64 slice technology or for screening.
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Medicare: Noridian (equipment have collimation of .625 mm or less and a rotational speed of 375 msec or less OR AT LEAST 64 SLICES)
Commerical Payers:
Aetna
Equipment must have 64 slices; considered medically necessary for: a) rule out stenosis for persons with low or very low pre-test risk based on Framingham or ACC criteria with any of the following indications: 1) persons with chest pain who cannot have exercise or pharmacologic stress testing; 2) persons with positive stress test; 3) evaluating chest pain in ER when imaging stress test or angiography are being deferred; b) evaluation of asymptomatic persons at low risk who have equivocal exercise or pharm. stress test; c) pre-op for persons undergoing high risk non cardiac surgery where imaging stress or angiography is being deferred; d) pre-op for planning noncoronary cardiac surgery in lieu of cardiac cath; e) detection of coronary anomalies in young persons (<30) with suggestive symptoms. considered experimental for persons with extensive calcification; atrial fib or other significant arrhythmia; inability to image at desired heart rate despite beta blockers; BMI>40, for asymptomatic persons or evaluation of persons at intermediate or high risk.
Cigna
Covers 64 slice or greater as adjunct to other testing for the following indications: 1) detection of CAD in symptomatic (ie chest pain) patients if intermediate pre-angiography probability of CAD and ECG uninterpretable or patient unable to exercise; 2) for detection of CAD in symptomatic patients if patient exhibits intermediate pre-angiography probability of CAD and no ECG changes and serial enzymes negative. Also covered for suspected congenital anomalies of coronary circulation or great vessels, suspected peripheral arterial disease independent of # of slices.
Humana
Coverage is limited to devices with slice thickness of 1 mm or less and at least 40 slices per rotation for the following indications: CTA may be used as an alternative to stress echo or stress radionuclide scan in patients who have an equivocal or suspected inaccurate stress EKG (not covered for patients with typical angina and an abnormal stress EKG or stress imaging test). Covered for suspected congenital abnormalities of coronary circulation, to evaluation of chest pain in the ER, and for the assessment of coronary or pulmonary venous anatomy.
United Healthcare
Covered when using machines with 64-slices or greater for the assessment of patients with known or suspected CAD. This includes patients with chest pain syndrome and intermediate pre-angiography probability of CAD when ECG is uninterpretable or patient is unable to exercise; patients with chest pain syndrome and prior uninterpretable or equivocal stress test or patients with acute chest pain and intermediate pre-angiography probability of CAD, no ECG changes and negative serial enzymes. Also covered for assessment of patients with known and suspected coronary anomalies or congenital heart disease. Not covered when using fewer than 64 slice technology or for screening
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Medicare: Noridian (equipment have collimation of .625 mm or less and a rotational speed of 375 msec or less OR AT LEAST 64 SLICES)
Commerical Payers:
Aetna
Equipment must have 64 slices; considered medically necessary for: a) rule out stenosis for persons with low or very low pre-test risk based on Framingham or ACC criteria with any of the following indications: 1) persons with chest pain who cannot have exercise or pharmacologic stress testing; 2) persons with positive stress test; 3) evaluating chest pain in ER when imaging stress test or angiography are being deferred; b) evaluation of asymptomatic persons at low risk who have equivocal exercise or pharm. stress test; c) pre-op for persons undergoing high risk non cardiac surgery where imaging stress or angiography is being deferred; d) pre-op for planning noncoronary cardiac surgery in lieu of cardiac cath; e) detection of coronary anomalies in young persons (<30) with suggestive symptoms. considered experimental for persons with extensive calcification; atrial fib or other significant arrhythmia; inability to image at desired heart rate despite beta blockers; BMI>40, for asymptomatic persons or evaluation of persons at intermediate or high risk
Cigna
Covers 64 slice or greater as adjunct to other testing for the following indications: 1) detection of CAD in symptomatic (ie chest pain) patients if intermediate pre-angiography probability of CAD and ECG uninterpretable or patient unable to exercise; 2) for detection of CAD in symptomatic patients if patient exhibits intermediate pre-angiography probability of CAD and no ECG changes and serial enzymes negative. Also covered for suspected congenital anomalies of coronary circulation or great vessels, suspected peripheral arterial disease independent of # of slices.
Humana
Coverage is limited to devices with slice thickness of 1 mm or less and at least 40 slices per rotation for the following indications: CTA may be used as an alternative to stress echo or stress radionuclide scan in patients who have an equivocal or suspected inaccurate stress EKG (not covered for patients with typical angina and an abnormal stress EKG or stress imaging test). Covered for suspected congenital abnormalities of coronary circulation, to evaluation of chest pain in the ER, and for the assessment of coronary or pulmonary venous anatomy.
United Healthcare
Covered when using machines with 64-slices or greater for the assessment of patients with known or suspected CAD. This includes patients with chest pain syndrome and intermediate pre-angiography probability of CAD when ECG is uninterpretable or patient is unable to exercise; patients with chest pain syndrome and prior uninterpretable or equivocal stress test or patients with acute chest pain and intermediate pre-angiography probability of CAD, no ECG changes and negative serial enzymes. Also covered for assessment of patients with known and suspected coronary anomalies or congenital heart disease. Not covered when using fewer than 64 slice technology or for screening.
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Medicare: Noridian (equipment have collimation of .625 mm or less and a rotational speed of 375 msec or less OR AT LEAST 64 SLICES)
Commerical Payers:
Aetna
Equipment must have 64 slices; considered medically necessary for: a) rule out stenosis for persons with low or very low pre-test risk based on Framingham or ACC criteria with any of the following indications: 1) persons with chest pain who cannot have exercise or pharmacologic stress testing; 2) persons with positive stress test; 3) evaluating chest pain in ER when imaging stress test or angiography are being deferred; b) evaluation of asymptomatic persons at low risk who have equivocal exercise or pharm. stress test; c) pre-op for persons undergoing high risk non cardiac surgery where imaging stress or angiography is being deferred; d) pre-op for planning noncoronary cardiac surgery in lieu of cardiac cath; e) detection of coronary anomalies in young persons (<30) with suggestive symptoms. considered experimental for persons with extensive calcification; atrial fib or other significant arrhythmia; inability to image at desired heart rate despite beta blockers; BMI>40, for asymptomatic persons or evaluation of persons at intermediate or high risk.
Cigna
Covers 64 slice or greater as adjunct to other testing for the following indications: 1) detection of CAD in symptomatic (ie chest pain) patients if intermediate pre-angiography probability of CAD and ECG uninterpretable or patient unable to exercise; 2) for detection of CAD in symptomatic patients if patient exhibits intermediate pre-angiography probability of CAD and no ECG changes and serial enzymes negative. Also covered for suspected congenital anomalies of coronary circulation or great vessels, suspected peripheral arterial disease independent of # of slices.
Humana
Coverage is limited to devices with slice thickness of 1 mm or less and at least 40 slices per rotation for the following indications: CTA may be used as an alternative to stress echo or stress radionuclide scan in patients who have an equivocal or suspected inaccurate stress EKG (not covered for patients with typical angina and an abnormal stress EKG or stress imaging test). Covered for suspected congenital abnormalities of coronary circulation, to evaluation of chest pain in the ER, and for the assessment of coronary or pulmonary venous anatomy.
United Healthcare
Covered when using machines with 64-slices or greater for the assessment of patients with known or suspected CAD. This includes patients with chest pain syndrome and intermediate pre-angiography probability of CAD when ECG is uninterpretable or patient is unable to exercise; patients with chest pain syndrome and prior uninterpretable or equivocal stress test or patients with acute chest pain and intermediate pre-angiography probability of CAD, no ECG changes and negative serial enzymes. Also covered for assessment of patients with known and suspected coronary anomalies or congenital heart disease. Not covered when using fewer than 64 slice technology or for screening.
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Medicare: Noridian (equipment have collimation of .625 mm or less and a rotational speed of 375 msec or less OR AT LEAST 64 SLICES)
Commerical Payers:
Aetna
Equipment must have 64 slices; considered medically necessary for: a) rule out stenosis for persons with low or very low pre-test risk based on Framingham or ACC criteria with any of the following indications: 1) persons with chest pain who cannot have exercise or pharmacologic stress testing; 2) persons with positive stress test; 3) evaluating chest pain in ER when imaging stress test or angiography are being deferred; b) evaluation of asymptomatic persons at low risk who have equivocal exercise or pharm. stress test; c) pre-op for persons undergoing high risk non cardiac surgery where imaging stress or angiography is being deferred; d) pre-op for planning noncoronary cardiac surgery in lieu of cardiac cath; e) detection of coronary anomalies in young persons (<30) with suggestive symptoms. considered experimental for persons with extensive calcification; atrial fib or other significant arrhythmia; inability to image at desired heart rate despite beta blockers; BMI>40, for asymptomatic persons or evaluation of persons at intermediate or high risk.
Cigna
Covers 64 slice or greater as adjunct to other testing for the following indications: 1) detection of CAD in symptomatic (ie chest pain) patients if intermediate pre-angiography probability of CAD and ECG uninterpretable or patient unable to exercise; 2) for detection of CAD in symptomatic patients if patient exhibits intermediate pre-angiography probability of CAD and no ECG changes and serial enzymes negative. Also covered for suspected congenital anomalies of coronary circulation or great vessels, suspected peripheral arterial disease independent of # of slices.
Humana
Coverage is limited to devices with slice thickness of 1 mm or less and at least 40 slices per rotation for the following indications: CTA may be used as an alternative to stress echo or stress radionuclide scan in patients who have an equivocal or suspected inaccurate stress EKG (not covered for patients with typical angina and an abnormal stress EKG or stress imaging test). Covered for suspected congenital abnormalities of coronary circulation, to evaluation of chest pain in the ER, and for the assessment of coronary or pulmonary venous anatomy.
United Healthcare
Covered when using machines with 64-slices or greater for the assessment of patients with known or suspected CAD. This includes patients with chest pain syndrome and intermediate pre-angiography probability of CAD when ECG is uninterpretable or patient is unable to exercise; patients with chest pain syndrome and prior uninterpretable or equivocal stress test or patients with acute chest pain and intermediate pre-angiography probability of CAD, no ECG changes and negative serial enzymes. Also covered for assessment of patients with known and suspected coronary anomalies or congenital heart disease. Not covered when using fewer than 64 slice technology or for screening.
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Medicare: Noridian (equipment have collimation of .625 mm or less and a rotational speed of 375 msec or less OR AT LEAST 64 SLICES)
Commerical Payers:
Aetna
Equipment must have 64 slices; considered medically necessary for: a) rule out stenosis for persons with low or very low pre-test risk based on Framingham or ACC criteria with any of the following indications: 1) persons with chest pain who cannot have exercise or pharmacologic stress testing; 2) persons with positive stress test; 3) evaluating chest pain in ER when imaging stress test or angiography are being deferred; b) evaluation of asymptomatic persons at low risk who have equivocal exercise or pharm. stress test; c) pre-op for persons undergoing high risk non cardiac surgery where imaging stress or angiography is being deferred; d) pre-op for planning noncoronary cardiac surgery in lieu of cardiac cath; e) detection of coronary anomalies in young persons (<30) with suggestive symptoms. considered experimental for persons with extensive calcification; atrial fib or other significant arrhythmia; inability to image at desired heart rate despite beta blockers; BMI>40, for asymptomatic persons or evaluation of persons at intermediate or high risk.
Cigna
Covers 64 slice or greater as adjunct to other testing for the following indications: 1) detection of CAD in symptomatic (ie chest pain) patients if intermediate pre-angiography probability of CAD and ECG uninterpretable or patient unable to exercise; 2) for detection of CAD in symptomatic patients if patient exhibits intermediate pre-angiography probability of CAD and no ECG changes and serial enzymes negative. Also covered for suspected congenital anomalies of coronary circulation or great vessels, suspected peripheral arterial disease independent of # of slices.
Humana
Coverage is limited to devices with slice thickness of 1 mm or less and at least 40 slices per rotation for the following indications: CTA may be used as an alternative to stress echo or stress radionuclide scan in patients who have an equivocal or suspected inaccurate stress EKG (not covered for patients with typical angina and an abnormal stress EKG or stress imaging test). Covered for suspected congenital abnormalities of coronary circulation, to evaluation of chest pain in the ER, and for the assessment of coronary or pulmonary venous anatomy.
United Healthcare
Covered when using machines with 64-slices or greater for the assessment of patients with known or suspected CAD. This includes patients with chest pain syndrome and intermediate pre-angiography probability of CAD when ECG is uninterpretable or patient is unable to exercise; patients with chest pain syndrome and prior uninterpretable or equivocal stress test or patients with acute chest pain and intermediate pre-angiography probability of CAD, no ECG changes and negative serial enzymes. Also covered for assessment of patients with known and suspected coronary anomalies or congenital heart disease. Not covered when using fewer than 64 slice technology or for screening.
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Medicare: Noridian (equipment have collimation of .625 mm or less and a rotational speed of 375 msec or less OR AT LEAST 64 SLICES)
Commerical Payers:
Aetna
Equipment must have 64 slices; considered medically necessary for: a) rule out stenosis for persons with low or very low pre-test risk based on Framingham or ACC criteria with any of the following indications: 1) persons with chest pain who cannot have exercise or pharmacologic stress testing; 2) persons with positive stress test; 3) evaluating chest pain in ER when imaging stress test or angiography are being deferred; b) evaluation of asymptomatic persons at low risk who have equivocal exercise or pharm. stress test; c) pre-op for persons undergoing high risk non cardiac surgery where imaging stress or angiography is being deferred; d) pre-op for planning noncoronary cardiac surgery in lieu of cardiac cath; e) detection of coronary anomalies in young persons (<30) with suggestive symptoms. considered experimental for persons with extensive calcification; atrial fib or other significant arrhythmia; inability to image at desired heart rate despite beta blockers; BMI>40, for asymptomatic persons or evaluation of persons at intermediate or high risk
Cigna
Covers 64 slice or greater as adjunct to other testing for the following indications: 1) detection of CAD in symptomatic (ie chest pain) patients if intermediate pre-angiography probability of CAD and ECG uninterpretable or patient unable to exercise; 2) for detection of CAD in symptomatic patients if patient exhibits intermediate pre-angiography probability of CAD and no ECG changes and serial enzymes negative. Also covered for suspected congenital anomalies of coronary circulation or great vessels, suspected peripheral arterial disease independent of # of slices.
Humana
Coverage is limited to devices with slice thickness of 1 mm or less and at least 40 slices per rotation for the following indications: CTA may be used as an alternative to stress echo or stress radionuclide scan in patients who have an equivocal or suspected inaccurate stress EKG (not covered for patients with typical angina and an abnormal stress EKG or stress imaging test). Covered for suspected congenital abnormalities of coronary circulation, to evaluation of chest pain in the ER, and for the assessment of coronary or pulmonary venous anatomy.
United Healthcare
Covered when using machines with 64-slices or greater for the assessment of patients with known or suspected CAD. This includes patients with chest pain syndrome and intermediate pre-angiography probability of CAD when ECG is uninterpretable or patient is unable to exercise; patients with chest pain syndrome and prior uninterpretable or equivocal stress test or patients with acute chest pain and intermediate pre-angiography probability of CAD, no ECG changes and negative serial enzymes. Also covered for assessment of patients with known and suspected coronary anomalies or congenital heart disease. Not covered when using fewer than 64 slice technology or for screening.
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Medicare: Noridian (equipment have collimation of .625 mm or less and a rotational speed of 375 msec or less OR AT LEAST 64 SLICES)
Commerical Payers:
Aetna
Equipment must have 64 slices; considered medically necessary for: a) rule out stenosis for persons with low or very low pre-test risk based on Framingham or ACC criteria with any of the following indications: 1) persons with chest pain who cannot have exercise or pharmacologic stress testing; 2) persons with positive stress test; 3) evaluating chest pain in ER when imaging stress test or angiography are being deferred; b) evaluation of asymptomatic persons at low risk who have equivocal exercise or pharm. stress test; c) pre-op for persons undergoing high risk non cardiac surgery where imaging stress or angiography is being deferred; d) pre-op for planning noncoronary cardiac surgery in lieu of cardiac cath; e) detection of coronary anomalies in young persons (<30) with suggestive symptoms. considered experimental for persons with extensive calcification; atrial fib or other significant arrhythmia; inability to image at desired heart rate despite beta blockers; BMI>40, for asymptomatic persons or evaluation of persons at intermediate or high risk.
Cigna
Covers 64 slice or greater as adjunct to other testing for the following indications: 1) detection of CAD in symptomatic (ie chest pain) patients if intermediate pre-angiography probability of CAD and ECG uninterpretable or patient unable to exercise; 2) for detection of CAD in symptomatic patients if patient exhibits intermediate pre-angiography probability of CAD and no ECG changes and serial enzymes negative. Also covered for suspected congenital anomalies of coronary circulation or great vessels, suspected peripheral arterial disease independent of # of slices.
Humana
Coverage is limited to devices with slice thickness of 1 mm or less and at least 40 slices per rotation for the following indications: CTA may be used as an alternative to stress echo or stress radionuclide scan in patients who have an equivocal or suspected inaccurate stress EKG (not covered for patients with typical angina and an abnormal stress EKG or stress imaging test). Covered for suspected congenital abnormalities of coronary circulation, to evaluation of chest pain in the ER, and for the assessment of coronary or pulmonary venous anatomy.
United Healthcare
Covered when using machines with 64-slices or greater for the assessment of patients with known or suspected CAD. This includes patients with chest pain syndrome and intermediate pre-angiography probability of CAD when ECG is uninterpretable or patient is unable to exercise; patients with chest pain syndrome and prior uninterpretable or equivocal stress test or patients with acute chest pain and intermediate pre-angiography probability of CAD, no ECG changes and negative serial enzymes. Also covered for assessment of patients with known and suspected coronary anomalies or congenital heart disease. Not covered when using fewer than 64 slice technology or for screening.
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Medicare: Noridian (equipment have collimation of .625 mm or less and a rotational speed of 375 msec or less OR AT LEAST 64 SLICES)
Commerical Payers:
Aetna
Equipment must have 64 slices; considered medically necessary for: a) rule out stenosis for persons with low or very low pre-test risk based on Framingham or ACC criteria with any of the following indications: 1) persons with chest pain who cannot have exercise or pharmacologic stress testing; 2) persons with positive stress test; 3) evaluating chest pain in ER when imaging stress test or angiography are being deferred; b) evaluation of asymptomatic persons at low risk who have equivocal exercise or pharm. stress test; c) pre-op for persons undergoing high risk non cardiac surgery where imaging stress or angiography is being deferred; d) pre-op for planning noncoronary cardiac surgery in lieu of cardiac cath; e) detection of coronary anomalies in young persons (<30) with suggestive symptoms. considered experimental for persons with extensive calcification; atrial fib or other significant arrhythmia; inability to image at desired heart rate despite beta blockers; BMI>40, for asymptomatic persons or evaluation of persons at intermediate or high risk.
Cigna
Covers 64 slice or greater as adjunct to other testing for the following indications: 1) detection of CAD in symptomatic (ie chest pain) patients if intermediate pre-angiography probability of CAD and ECG uninterpretable or patient unable to exercise; 2) for detection of CAD in symptomatic patients if patient exhibits intermediate pre-angiography probability of CAD and no ECG changes and serial enzymes negative. Also covered for suspected congenital anomalies of coronary circulation or great vessels, suspected peripheral arterial disease independent of # of slices.
Humana
Coverage is limited to devices with slice thickness of 1 mm or less and at least 40 slices per rotation for the following indications: CTA may be used as an alternative to stress echo or stress radionuclide scan in patients who have an equivocal or suspected inaccurate stress EKG (not covered for patients with typical angina and an abnormal stress EKG or stress imaging test). Covered for suspected congenital abnormalities of coronary circulation, to evaluation of chest pain in the ER, and for the assessment of coronary or pulmonary venous anatomy.
United Healthcare
Covered when using machines with 64-slices or greater for the assessment of patients with known or suspected CAD. This includes patients with chest pain syndrome and intermediate pre-angiography probability of CAD when ECG is uninterpretable or patient is unable to exercise; patients with chest pain syndrome and prior uninterpretable or equivocal stress test or patients with acute chest pain and intermediate pre-angiography probability of CAD, no ECG changes and negative serial enzymes. Also covered for assessment of patients with known and suspected coronary anomalies or congenital heart disease. Not covered when using fewer than 64 slice technology or for screening.
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Medicare: Noridian (equipment have collimation of .625 mm or less and a rotational speed of 375 msec or less OR AT LEAST 64 SLICES)
Commerical Payers:
Aetna
Equipment must have 64 slices; considered medically necessary for: a) rule out stenosis for persons with low or very low pre-test risk based on Framingham or ACC criteria with any of the following indications: 1) persons with chest pain who cannot have exercise or pharmacologic stress testing; 2) persons with positive stress test; 3) evaluating chest pain in ER when imaging stress test or angiography are being deferred; b) evaluation of asymptomatic persons at low risk who have equivocal exercise or pharm. stress test; c) pre-op for persons undergoing high risk non cardiac surgery where imaging stress or angiography is being deferred; d) pre-op for planning noncoronary cardiac surgery in lieu of cardiac cath; e) detection of coronary anomalies in young persons (<30) with suggestive symptoms. considered experimental for persons with extensive calcification; atrial fib or other significant arrhythmia; inability to image at desired heart rate despite beta blockers; BMI>40, for asymptomatic persons or evaluation of persons at intermediate or high risk
Cigna
Covers 64 slice or greater as adjunct to other testing for the following indications: 1) detection of CAD in symptomatic (ie chest pain) patients if intermediate pre-angiography probability of CAD and ECG uninterpretable or patient unable to exercise; 2) for detection of CAD in symptomatic patients if patient exhibits intermediate pre-angiography probability of CAD and no ECG changes and serial enzymes negative. Also covered for suspected congenital anomalies of coronary circulation or great vessels, suspected peripheral arterial disease independent of # of slices.
Humana
Coverage is limited to devices with slice thickness of 1 mm or less and at least 40 slices per rotation for the following indications: CTA may be used as an alternative to stress echo or stress radionuclide scan in patients who have an equivocal or suspected inaccurate stress EKG (not covered for patients with typical angina and an abnormal stress EKG or stress imaging test). Covered for suspected congenital abnormalities of coronary circulation, to evaluation of chest pain in the ER, and for the assessment of coronary or pulmonary venous anatomy.
United Healthcare
Covered when using machines with 64-slices or greater for the assessment of patients with known or suspected CAD. This includes patients with chest pain syndrome and intermediate pre-angiography probability of CAD when ECG is uninterpretable or patient is unable to exercise; patients with chest pain syndrome and prior uninterpretable or equivocal stress test or patients with acute chest pain and intermediate pre-angiography probability of CAD, no ECG changes and negative serial enzymes. Also covered for assessment of patients with known and suspected coronary anomalies or congenital heart disease. Not covered when using fewer than 64 slice technology or for screening.
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Medicare: Noridian (equipment have collimation of .625 mm or less and a rotational speed of 375 msec or less OR AT LEAST 64 SLICES)
Commerical Payers:
Aetna
Equipment must have 64 slices; considered medically necessary for: a) rule out stenosis for persons with low or very low pre-test risk based on Framingham or ACC criteria with any of the following indications: 1) persons with chest pain who cannot have exercise or pharmacologic stress testing; 2) persons with positive stress test; 3) evaluating chest pain in ER when imaging stress test or angiography are being deferred; b) evaluation of asymptomatic persons at low risk who have equivocal exercise or pharm. stress test; c) pre-op for persons undergoing high risk non cardiac surgery where imaging stress or angiography is being deferred; d) pre-op for planning noncoronary cardiac surgery in lieu of cardiac cath; e) detection of coronary anomalies in young persons (<30) with suggestive symptoms. considered experimental for persons with extensive calcification; atrial fib or other significant arrhythmia; inability to image at desired heart rate despite beta blockers; BMI>40, for asymptomatic persons or evaluation of persons at intermediate or high risk.
Cigna
Covers 64 slice or greater as adjunct to other testing for the following indications: 1) detection of CAD in symptomatic (ie chest pain) patients if intermediate pre-angiography probability of CAD and ECG uninterpretable or patient unable to exercise; 2) for detection of CAD in symptomatic patients if patient exhibits intermediate pre-angiography probability of CAD and no ECG changes and serial enzymes negative. Also covered for suspected congenital anomalies of coronary circulation or great vessels, suspected peripheral arterial disease independent of # of slices.
Humana
Coverage is limited to devices with slice thickness of 1 mm or less and at least 40 slices per rotation for the following indications: CTA may be used as an alternative to stress echo or stress radionuclide scan in patients who have an equivocal or suspected inaccurate stress EKG (not covered for patients with typical angina and an abnormal stress EKG or stress imaging test). Covered for suspected congenital abnormalities of coronary circulation, to evaluation of chest pain in the ER, and for the assessment of coronary or pulmonary venous anatomy.
United Healthcare
Covered when using machines with 64-slices or greater for the assessment of patients with known or suspected CAD. This includes patients with chest pain syndrome and intermediate pre-angiography probability of CAD when ECG is uninterpretable or patient is unable to exercise; patients with chest pain syndrome and prior uninterpretable or equivocal stress test or patients with acute chest pain and intermediate pre-angiography probability of CAD, no ECG changes and negative serial enzymes. Also covered for assessment of patients with known and suspected coronary anomalies or congenital heart disease. Not covered when using fewer than 64 slice technology or for screening.
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Medicare: Noridian (equipment have collimation of .625 mm or less and a rotational speed of 375 msec or less OR AT LEAST 64 SLICES)
Commerical Payers:
Aetna
Equipment must have 64 slices; considered medically necessary for: a) rule out stenosis for persons with low or very low pre-test risk based on Framingham or ACC criteria with any of the following indications: 1) persons with chest pain who cannot have exercise or pharmacologic stress testing; 2) persons with positive stress test; 3) evaluating chest pain in ER when imaging stress test or angiography are being deferred; b) evaluation of asymptomatic persons at low risk who have equivocal exercise or pharm. stress test; c) pre-op for persons undergoing high risk non cardiac surgery where imaging stress or angiography is being deferred; d) pre-op for planning noncoronary cardiac surgery in lieu of cardiac cath; e) detection of coronary anomalies in young persons (<30) with suggestive symptoms. considered experimental for persons with extensive calcification; atrial fib or other significant arrhythmia; inability to image at desired heart rate despite beta blockers; BMI>40, for asymptomatic persons or evaluation of persons at intermediate or high risk.
Cigna
Covers 64 slice or greater as adjunct to other testing for the following indications: 1) detection of CAD in symptomatic (ie chest pain) patients if intermediate pre-angiography probability of CAD and ECG uninterpretable or patient unable to exercise; 2) for detection of CAD in symptomatic patients if patient exhibits intermediate pre-angiography probability of CAD and no ECG changes and serial enzymes negative. Also covered for suspected congenital anomalies of coronary circulation or great vessels, suspected peripheral arterial disease independent of # of slices.
Humana
Coverage is limited to devices with slice thickness of 1 mm or less and at least 40 slices per rotation for the following indications: CTA may be used as an alternative to stress echo or stress radionuclide scan in patients who have an equivocal or suspected inaccurate stress EKG (not covered for patients with typical angina and an abnormal stress EKG or stress imaging test). Covered for suspected congenital abnormalities of coronary circulation, to evaluation of chest pain in the ER, and for the assessment of coronary or pulmonary venous anatomy.
United Healthcare
Covered when using machines with 64-slices or greater for the assessment of patients with known or suspected CAD. This includes patients with chest pain syndrome and intermediate pre-angiography probability of CAD when ECG is uninterpretable or patient is unable to exercise; patients with chest pain syndrome and prior uninterpretable or equivocal stress test or patients with acute chest pain and intermediate pre-angiography probability of CAD, no ECG changes and negative serial enzymes. Also covered for assessment of patients with known and suspected coronary anomalies or congenital heart disease. Not covered when using fewer than 64 slice technology or for screening.
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Medicare: Noridian (equipment have collimation of .625 mm or less and a rotational speed of 375 msec or less OR AT LEAST 64 SLICES)
Commerical Payers:
Aetna
Equipment must have 64 slices; considered medically necessary for: a) rule out stenosis for persons with low or very low pre-test risk based on Framingham or ACC criteria with any of the following indications: 1) persons with chest pain who cannot have exercise or pharmacologic stress testing; 2) persons with positive stress test; 3) evaluating chest pain in ER when imaging stress test or angiography are being deferred; b) evaluation of asymptomatic persons at low risk who have equivocal exercise or pharm. stress test; c) pre-op for persons undergoing high risk non cardiac surgery where imaging stress or angiography is being deferred; d) pre-op for planning noncoronary cardiac surgery in lieu of cardiac cath; e) detection of coronary anomalies in young persons (<30) with suggestive symptoms. considered experimental for persons with extensive calcification; atrial fib or other significant arrhythmia; inability to image at desired heart rate despite beta blockers; BMI>40, for asymptomatic persons or evaluation of persons at intermediate or high risk.
Cigna
Covers 64 slice or greater as adjunct to other testing for the following indications: 1) detection of CAD in symptomatic (ie chest pain) patients if intermediate pre-angiography probability of CAD and ECG uninterpretable or patient unable to exercise; 2) for detection of CAD in symptomatic patients if patient exhibits intermediate pre-angiography probability of CAD and no ECG changes and serial enzymes negative. Also covered for suspected congenital anomalies of coronary circulation or great vessels, suspected peripheral arterial disease independent of # of slices.
Humana
Coverage is limited to devices with slice thickness of 1 mm or less and at least 40 slices per rotation for the following indications: CTA may be used as an alternative to stress echo or stress radionuclide scan in patients who have an equivocal or suspected inaccurate stress EKG (not covered for patients with typical angina and an abnormal stress EKG or stress imaging test). Covered for suspected congenital abnormalities of coronary circulation, to evaluation of chest pain in the ER, and for the assessment of coronary or pulmonary venous anatomy.
United Healthcare
Covered when using machines with 64-slices or greater for the assessment of patients with known or suspected CAD. This includes patients with chest pain syndrome and intermediate pre-angiography probability of CAD when ECG is uninterpretable or patient is unable to exercise; patients with chest pain syndrome and prior uninterpretable or equivocal stress test or patients with acute chest pain and intermediate pre-angiography probability of CAD, no ECG changes and negative serial enzymes. Also covered for assessment of patients with known and suspected coronary anomalies or congenital heart disease. Not covered when using fewer than 64 slice technology or for screening.
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Medicare: Noridian (equipment have collimation of .625 mm or less and a rotational speed of 375 msec or less OR AT LEAST 64 SLICES)
Commerical Payers:
Aetna
Equipment must have 64 slices; considered medically necessary for: a) rule out stenosis for persons with low or very low pre-test risk based on Framingham or ACC criteria with any of the following indications: 1) persons with chest pain who cannot have exercise or pharmacologic stress testing; 2) persons with positive stress test; 3) evaluating chest pain in ER when imaging stress test or angiography are being deferred; b) evaluation of asymptomatic persons at low risk who have equivocal exercise or pharm. stress test; c) pre-op for persons undergoing high risk non cardiac surgery where imaging stress or angiography is being deferred; d) pre-op for planning noncoronary cardiac surgery in lieu of cardiac cath; e) detection of coronary anomalies in young persons (<30) with suggestive symptoms. considered experimental for persons with extensive calcification; atrial fib or other significant arrhythmia; inability to image at desired heart rate despite beta blockers; BMI>40, for asymptomatic persons or evaluation of persons at intermediate or high risk.
Cigna
Covers 64 slice or greater as adjunct to other testing for the following indications: 1) detection of CAD in symptomatic (ie chest pain) patients if intermediate pre-angiography probability of CAD and ECG uninterpretable or patient unable to exercise; 2) for detection of CAD in symptomatic patients if patient exhibits intermediate pre-angiography probability of CAD and no ECG changes and serial enzymes negative. Also covered for suspected congenital anomalies of coronary circulation or great vessels, suspected peripheral arterial disease independent of # of slices.
Humana
Coverage is limited to devices with slice thickness of 1 mm or less and at least 40 slices per rotation for the following indications: CTA may be used as an alternative to stress echo or stress radionuclide scan in patients who have an equivocal or suspected inaccurate stress EKG (not covered for patients with typical angina and an abnormal stress EKG or stress imaging test). Covered for suspected congenital abnormalities of coronary circulation, to evaluation of chest pain in the ER, and for the assessment of coronary or pulmonary venous anatomy.
United Healthcare
Covered when using machines with 64-slices or greater for the assessment of patients with known or suspected CAD. This includes patients with chest pain syndrome and intermediate pre-angiography probability of CAD when ECG is uninterpretable or patient is unable to exercise; patients with chest pain syndrome and prior uninterpretable or equivocal stress test or patients with acute chest pain and intermediate pre-angiography probability of CAD, no ECG changes and negative serial enzymes. Also covered for assessment of patients with known and suspected coronary anomalies or congenital heart disease. Not covered when using fewer than 64 slice technology or for screening.
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Medicare: Noridian (equipment have collimation of .625 mm or less and a rotational speed of 375 msec or less OR AT LEAST 64 SLICES)
Commerical Payers:
Aetna
Equipment must have 64 slices; considered medically necessary for: a) rule out stenosis for persons with low or very low pre-test risk based on Framingham or ACC criteria with any of the following indications: 1) persons with chest pain who cannot have exercise or pharmacologic stress testing; 2) persons with positive stress test; 3) evaluating chest pain in ER when imaging stress test or angiography are being deferred; b) evaluation of asymptomatic persons at low risk who have equivocal exercise or pharm. stress test; c) pre-op for persons undergoing high risk non cardiac surgery where imaging stress or angiography is being deferred; d) pre-op for planning noncoronary cardiac surgery in lieu of cardiac cath; e) detection of coronary anomalies in young persons (<30) with suggestive symptoms. considered experimental for persons with extensive calcification; atrial fib or other significant arrhythmia; inability to image at desired heart rate despite beta blockers; BMI>40, for asymptomatic persons or evaluation of persons at intermediate or high risk.
Cigna
Covers 64 slice or greater as adjunct to other testing for the following indications: 1) detection of CAD in symptomatic (ie chest pain) patients if intermediate pre-angiography probability of CAD and ECG uninterpretable or patient unable to exercise; 2) for detection of CAD in symptomatic patients if patient exhibits intermediate pre-angiography probability of CAD and no ECG changes and serial enzymes negative. Also covered for suspected congenital anomalies of coronary circulation or great vessels, suspected peripheral arterial disease independent of # of slices.
Humana
Coverage is limited to devices with slice thickness of 1 mm or less and at least 40 slices per rotation for the following indications: CTA may be used as an alternative to stress echo or stress radionuclide scan in patients who have an equivocal or suspected inaccurate stress EKG (not covered for patients with typical angina and an abnormal stress EKG or stress imaging test). Covered for suspected congenital abnormalities of coronary circulation, to evaluation of chest pain in the ER, and for the assessment of coronary or pulmonary venous anatomy.
United Healthcare
Covered when using machines with 64-slices or greater for the assessment of patients with known or suspected CAD. This includes patients with chest pain syndrome and intermediate pre-angiography probability of CAD when ECG is uninterpretable or patient is unable to exercise; patients with chest pain syndrome and prior uninterpretable or equivocal stress test or patients with acute chest pain and intermediate pre-angiography probability of CAD, no ECG changes and negative serial enzymes. Also covered for assessment of patients with known and suspected coronary anomalies or congenital heart disease. Not covered when using fewer than 64 slice technology or for screening.
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Medicare: Noridian (equipment have collimation of .625 mm or less and a rotational speed of 375 msec or less OR AT LEAST 64 SLICES)
Commerical Payers:
Aetna
Equipment must have 64 slices; considered medically necessary for: a) rule out stenosis for persons with low or very low pre-test risk based on Framingham or ACC criteria with any of the following indications: 1) persons with chest pain who cannot have exercise or pharmacologic stress testing; 2) persons with positive stress test; 3) evaluating chest pain in ER when imaging stress test or angiography are being deferred; b) evaluation of asymptomatic persons at low risk who have equivocal exercise or pharm. stress test; c) pre-op for persons undergoing high risk non cardiac surgery where imaging stress or angiography is being deferred; d) pre-op for planning noncoronary cardiac surgery in lieu of cardiac cath; e) detection of coronary anomalies in young persons (<30) with suggestive symptoms. considered experimental for persons with extensive calcification; atrial fib or other significant arrhythmia; inability to image at desired heart rate despite beta blockers; BMI>40, for asymptomatic persons or evaluation of persons at intermediate or high risk.
Cigna
Covers 64 slice or greater as adjunct to other testing for the following indications: 1) detection of CAD in symptomatic (ie chest pain) patients if intermediate pre-angiography probability of CAD and ECG uninterpretable or patient unable to exercise; 2) for detection of CAD in symptomatic patients if patient exhibits intermediate pre-angiography probability of CAD and no ECG changes and serial enzymes negative. Also covered for suspected congenital anomalies of coronary circulation or great vessels, suspected peripheral arterial disease independent of # of slices.
Humana
Coverage is limited to devices with slice thickness of 1 mm or less and at least 40 slices per rotation for the following indications: CTA may be used as an alternative to stress echo or stress radionuclide scan in patients who have an equivocal or suspected inaccurate stress EKG (not covered for patients with typical angina and an abnormal stress EKG or stress imaging test). Covered for suspected congenital abnormalities of coronary circulation, to evaluation of chest pain in the ER, and for the assessment of coronary or pulmonary venous anatomy.
United Healthcare
Covered when using machines with 64-slices or greater for the assessment of patients with known or suspected CAD. This includes patients with chest pain syndrome and intermediate pre-angiography probability of CAD when ECG is uninterpretable or patient is unable to exercise; patients with chest pain syndrome and prior uninterpretable or equivocal stress test or patients with acute chest pain and intermediate pre-angiography probability of CAD, no ECG changes and negative serial enzymes. Also covered for assessment of patients with known and suspected coronary anomalies or congenital heart disease. Not covered when using fewer than 64 slice technology or for screening.
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Medicare: Noridian (equipment have collimation of .625 mm or less and a rotational speed of 375 msec or less OR AT LEAST 64 SLICES)
Commerical Payers:
Aetna
Equipment must have 64 slices; considered medically necessary for: a) rule out stenosis for persons with low or very low pre-test risk based on Framingham or ACC criteria with any of the following indications: 1) persons with chest pain who cannot have exercise or pharmacologic stress testing; 2) persons with positive stress test; 3) evaluating chest pain in ER when imaging stress test or angiography are being deferred; b) evaluation of asymptomatic persons at low risk who have equivocal exercise or pharm. stress test; c) pre-op for persons undergoing high risk non cardiac surgery where imaging stress or angiography is being deferred; d) pre-op for planning noncoronary cardiac surgery in lieu of cardiac cath; e) detection of coronary anomalies in young persons (<30) with suggestive symptoms. considered experimental for persons with extensive calcification; atrial fib or other significant arrhythmia; inability to image at desired heart rate despite beta blockers; BMI>40, for asymptomatic persons or evaluation of persons at intermediate or high risk.
Cigna
Covers 64 slice or greater as adjunct to other testing for the following indications: 1) detection of CAD in symptomatic (ie chest pain) patients if intermediate pre-angiography probability of CAD and ECG uninterpretable or patient unable to exercise; 2) for detection of CAD in symptomatic patients if patient exhibits intermediate pre-angiography probability of CAD and no ECG changes and serial enzymes negative. Also covered for suspected congenital anomalies of coronary circulation or great vessels, suspected peripheral arterial disease independent of # of slices.
Humana
Coverage is limited to devices with slice thickness of 1 mm or less and at least 40 slices per rotation for the following indications: CTA may be used as an alternative to stress echo or stress radionuclide scan in patients who have an equivocal or suspected inaccurate stress EKG (not covered for patients with typical angina and an abnormal stress EKG or stress imaging test). Covered for suspected congenital abnormalities of coronary circulation, to evaluation of chest pain in the ER, and for the assessment of coronary or pulmonary venous anatomy.
United Healthcare
Covered when using machines with 64-slices or greater for the assessment of patients with known or suspected CAD. This includes patients with chest pain syndrome and intermediate pre-angiography probability of CAD when ECG is uninterpretable or patient is unable to exercise; patients with chest pain syndrome and prior uninterpretable or equivocal stress test or patients with acute chest pain and intermediate pre-angiography probability of CAD, no ECG changes and negative serial enzymes. Also covered for assessment of patients with known and suspected coronary anomalies or congenital heart disease. Not covered when using fewer than 64 slice technology or for screening.
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Medicare: Noridian (equipment have collimation of .625 mm or less and a rotational speed of 375 msec or less OR AT LEAST 64 SLICES)
Commerical Payers:
Aetna
Equipment must have 64 slices; considered medically necessary for: a) rule out stenosis for persons with low or very low pre-test risk based on Framingham or ACC criteria with any of the following indications: 1) persons with chest pain who cannot have exercise or pharmacologic stress testing; 2) persons with positive stress test; 3) evaluating chest pain in ER when imaging stress test or angiography are being deferred; b) evaluation of asymptomatic persons at low risk who have equivocal exercise or pharm. stress test; c) pre-op for persons undergoing high risk non cardiac surgery where imaging stress or angiography is being deferred; d) pre-op for planning noncoronary cardiac surgery in lieu of cardiac cath; e) detection of coronary anomalies in young persons (<30) with suggestive symptoms. considered experimental for persons with extensive calcification; atrial fib or other significant arrhythmia; inability to image at desired heart rate despite beta blockers; BMI>40, for asymptomatic persons or evaluation of persons at intermediate or high risk.
Cigna
Covers 64 slice or greater as adjunct to other testing for the following indications: 1) detection of CAD in symptomatic (ie chest pain) patients if intermediate pre-angiography probability of CAD and ECG uninterpretable or patient unable to exercise; 2) for detection of CAD in symptomatic patients if patient exhibits intermediate pre-angiography probability of CAD and no ECG changes and serial enzymes negative. Also covered for suspected congenital anomalies of coronary circulation or great vessels, suspected peripheral arterial disease independent of # of slices.
Humana
Coverage is limited to devices with slice thickness of 1 mm or less and at least 40 slices per rotation for the following indications: CTA may be used as an alternative to stress echo or stress radionuclide scan in patients who have an equivocal or suspected inaccurate stress EKG (not covered for patients with typical angina and an abnormal stress EKG or stress imaging test). Covered for suspected congenital abnormalities of coronary circulation, to evaluation of chest pain in the ER, and for the assessment of coronary or pulmonary venous anatomy.
United Healthcare
Covered when using machines with 64-slices or greater for the assessment of patients with known or suspected CAD. This includes patients with chest pain syndrome and intermediate pre-angiography probability of CAD when ECG is uninterpretable or patient is unable to exercise; patients with chest pain syndrome and prior uninterpretable or equivocal stress test or patients with acute chest pain and intermediate pre-angiography probability of CAD, no ECG changes and negative serial enzymes. Also covered for assessment of patients with known and suspected coronary anomalies or congenital heart disease. Not covered when using fewer than 64 slice technology or for screening.
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Medicare: Noridian (equipment have collimation of .625 mm or less and a rotational speed of 375 msec or less OR AT LEAST 64 SLICES)
Commerical Payers:
Aetna
Equipment must have 64 slices; considered medically necessary for: a) rule out stenosis for persons with low or very low pre-test risk based on Framingham or ACC criteria with any of the following indications: 1) persons with chest pain who cannot have exercise or pharmacologic stress testing; 2) persons with positive stress test; 3) evaluating chest pain in ER when imaging stress test or angiography are being deferred; b) evaluation of asymptomatic persons at low risk who have equivocal exercise or pharm. stress test; c) pre-op for persons undergoing high risk non cardiac surgery where imaging stress or angiography is being deferred; d) pre-op for planning noncoronary cardiac surgery in lieu of cardiac cath; e) detection of coronary anomalies in young persons (<30) with suggestive symptoms. considered experimental for persons with extensive calcification; atrial fib or other significant arrhythmia; inability to image at desired heart rate despite beta blockers; BMI>40, for asymptomatic persons or evaluation of persons at intermediate or high risk
Cigna
Covers 64 slice or greater as adjunct to other testing for the following indications: 1) detection of CAD in symptomatic (ie chest pain) patients if intermediate pre-angiography probability of CAD and ECG uninterpretable or patient unable to exercise; 2) for detection of CAD in symptomatic patients if patient exhibits intermediate pre-angiography probability of CAD and no ECG changes and serial enzymes negative. Also covered for suspected congenital anomalies of coronary circulation or great vessels, suspected peripheral arterial disease independent of # of slices.
Humana
Coverage is limited to devices with slice thickness of 1 mm or less and at least 40 slices per rotation for the following indications: CTA may be used as an alternative to stress echo or stress radionuclide scan in patients who have an equivocal or suspected inaccurate stress EKG (not covered for patients with typical angina and an abnormal stress EKG or stress imaging test). Covered for suspected congenital abnormalities of coronary circulation, to evaluation of chest pain in the ER, and for the assessment of coronary or pulmonary venous anatomy.
United Healthcare
Covered when using machines with 64-slices or greater for the assessment of patients with known or suspected CAD. This includes patients with chest pain syndrome and intermediate pre-angiography probability of CAD when ECG is uninterpretable or patient is unable to exercise; patients with chest pain syndrome and prior uninterpretable or equivocal stress test or patients with acute chest pain and intermediate pre-angiography probability of CAD, no ECG changes and negative serial enzymes. Also covered for assessment of patients with known and suspected coronary anomalies or congenital heart disease. Not covered when using fewer than 64 slice technology or for screening.
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Medicare: Noridian (equipment have collimation of .625 mm or less and a rotational speed of 375 msec or less OR AT LEAST 64 SLICES)
Commerical Payers:
Aetna
equipment must have 64 slices; considered medically necessary for: a) rule out stenosis for persons with low or very low pre-test risk based on Framingham or ACC criteria with any of the following indications: 1) persons with chest pain who cannot have exercise or pharmacologic stress testing; 2) persons with positive stress test; 3) evaluating chest pain in ER when imaging stress test or angiography are being deferred; b) evaluation of asymptomatic persons at low risk who have equivocal exercise or pharm. stress test; c) pre-op for persons undergoing high risk non cardiac surgery where imaging stress or angiography is being deferred; d) pre-op for planning noncoronary cardiac surgery in lieu of cardiac cath; e) detection of coronary anomalies in young persons (<30) with suggestive symptoms. considered experimental for persons with extensive calcification; atrial fib or other significant arrhythmia; inability to image at desired heart rate despite beta blockers; BMI>40, for asymptomatic persons or evaluation of persons at intermediate or high risk
Cigna
Covers 64 slice or greater as adjunct to other testing for the following indications: 1) detection of CAD in symptomatic (ie chest pain) patients if intermediate pre-angiography probability of CAD and ECG uninterpretable or patient unable to exercise; 2) for detection of CAD in symptomatic patients if patient exhibits intermediate pre-angiography probability of CAD and no ECG changes and serial enzymes negative. Also covered for suspected congenital anomalies of coronary circulation or great vessels, suspected peripheral arterial disease independent of # of slices.
Humana
Coverage is limited to devices with slice thickness of 1 mm or less and at least 40 slices per rotation for the following indications: CTA may be used as an alternative to stress echo or stress radionuclide scan in patients who have an equivocal or suspected inaccurate stress EKG (not covered for patients with typical angina and an abnormal stress EKG or stress imaging test). Covered for suspected congenital abnormalities of coronary circulation, to evaluation of chest pain in the ER, and for the assessment of coronary or pulmonary venous anatomy.
United Healthcare
Covered when using machines with 64-slices or greater for the assessment of patients with known or suspected CAD. This includes patients with chest pain syndrome and intermediate pre-angiography probability of CAD when ECG is uninterpretable or patient is unable to exercise; patients with chest pain syndrome and prior uninterpretable or equivocal stress test or patients with acute chest pain and intermediate pre-angiography probability of CAD, no ECG changes and negative serial enzymes. Also covered for assessment of patients with known and suspected coronary anomalies or congenital heart disease. Not covered when using fewer than 64 slice technology or for screening.
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Medicare: Noridian (equipment have collimation of .625 mm or less and a rotational speed of 375 msec or less OR AT LEAST 64 SLICES)
Commerical Payers:
Aetna
Equipment must have 64 slices; considered medically necessary for: a) rule out stenosis for persons with low or very low pre-test risk based on Framingham or ACC criteria with any of the following indications: 1) persons with chest pain who cannot have exercise or pharmacologic stress testing; 2) persons with positive stress test; 3) evaluating chest pain in ER when imaging stress test or angiography are being deferred; b) evaluation of asymptomatic persons at low risk who have equivocal exercise or pharm. stress test; c) pre-op for persons undergoing high risk non cardiac surgery where imaging stress or angiography is being deferred; d) pre-op for planning noncoronary cardiac surgery in lieu of cardiac cath; e) detection of coronary anomalies in young persons (<30) with suggestive symptoms. considered experimental for persons with extensive calcification; atrial fib or other significant arrhythmia; inability to image at desired heart rate despite beta blockers; BMI>40, for asymptomatic persons or evaluation of persons at intermediate or high risk.
Cigna
Covers 64 slice or greater as adjunct to other testing for the following indications: 1) detection of CAD in symptomatic (ie chest pain) patients if intermediate pre-angiography probability of CAD and ECG uninterpretable or patient unable to exercise; 2) for detection of CAD in symptomatic patients if patient exhibits intermediate pre-angiography probability of CAD and no ECG changes and serial enzymes negative. Also covered for suspected congenital anomalies of coronary circulation or great vessels, suspected peripheral arterial disease independent of # of slices.
Humana
Coverage is limited to devices with slice thickness of 1 mm or less and at least 40 slices per rotation for the following indications: CTA may be used as an alternative to stress echo or stress radionuclide scan in patients who have an equivocal or suspected inaccurate stress EKG (not covered for patients with typical angina and an abnormal stress EKG or stress imaging test). Covered for suspected congenital abnormalities of coronary circulation, to evaluation of chest pain in the ER, and for the assessment of coronary or pulmonary venous anatomy.
United Healthcare
Covered when using machines with 64-slices or greater for the assessment of patients with known or suspected CAD. This includes patients with chest pain syndrome and intermediate pre-angiography probability of CAD when ECG is uninterpretable or patient is unable to exercise; patients with chest pain syndrome and prior uninterpretable or equivocal stress test or patients with acute chest pain and intermediate pre-angiography probability of CAD, no ECG changes and negative serial enzymes. Also covered for assessment of patients with known and suspected coronary anomalies or congenital heart disease. Not covered when using fewer than 64 slice technology or for screening.
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Medicare: Noridian (equipment have collimation of .625 mm or less and a rotational speed of 375 msec or less OR AT LEAST 64 SLICES)
Commerical Payers:
Aetna
Equipment must have 64 slices; considered medically necessary for: a) rule out stenosis for persons with low or very low pre-test risk based on Framingham or ACC criteria with any of the following indications: 1) persons with chest pain who cannot have exercise or pharmacologic stress testing; 2) persons with positive stress test; 3) evaluating chest pain in ER when imaging stress test or angiography are being deferred; b) evaluation of asymptomatic persons at low risk who have equivocal exercise or pharm. stress test; c) pre-op for persons undergoing high risk non cardiac surgery where imaging stress or angiography is being deferred; d) pre-op for planning noncoronary cardiac surgery in lieu of cardiac cath; e) detection of coronary anomalies in young persons (<30) with suggestive symptoms. considered experimental for persons with extensive calcification; atrial fib or other significant arrhythmia; inability to image at desired heart rate despite beta blockers; BMI>40, for asymptomatic persons or evaluation of persons at intermediate or high risk
Cigna
Covers 64 slice or greater as adjunct to other testing for the following indications: 1) detection of CAD in symptomatic (ie chest pain) patients if intermediate pre-angiography probability of CAD and ECG uninterpretable or patient unable to exercise; 2) for detection of CAD in symptomatic patients if patient exhibits intermediate pre-angiography probability of CAD and no ECG changes and serial enzymes negative. Also covered for suspected congenital anomalies of coronary circulation or great vessels, suspected peripheral arterial disease independent of # of slices.
Humana
Coverage is limited to devices with slice thickness of 1 mm or less and at least 40 slices per rotation for the following indications: CTA may be used as an alternative to stress echo or stress radionuclide scan in patients who have an equivocal or suspected inaccurate stress EKG (not covered for patients with typical angina and an abnormal stress EKG or stress imaging test). Covered for suspected congenital abnormalities of coronary circulation, to evaluation of chest pain in the ER, and for the assessment of coronary or pulmonary venous anatomy.
United Healthcare
Covered when using machines with 64-slices or greater for the assessment of patients with known or suspected CAD. This includes patients with chest pain syndrome and intermediate pre-angiography probability of CAD when ECG is uninterpretable or patient is unable to exercise; patients with chest pain syndrome and prior uninterpretable or equivocal stress test or patients with acute chest pain and intermediate pre-angiography probability of CAD, no ECG changes and negative serial enzymes. Also covered for assessment of patients with known and suspected coronary anomalies or congenital heart disease. Not covered when using fewer than 64 slice technology or for screening.
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Medicare: Noridian (equipment have collimation of .625 mm or less and a rotational speed of 375 msec or less OR AT LEAST 64 SLICES)
Commerical Payers:
Aetna
Equipment must have 64 slices; considered medically necessary for: a) rule out stenosis for persons with low or very low pre-test risk based on Framingham or ACC criteria with any of the following indications: 1) persons with chest pain who cannot have exercise or pharmacologic stress testing; 2) persons with positive stress test; 3) evaluating chest pain in ER when imaging stress test or angiography are being deferred; b) evaluation of asymptomatic persons at low risk who have equivocal exercise or pharm. stress test; c) pre-op for persons undergoing high risk non cardiac surgery where imaging stress or angiography is being deferred; d) pre-op for planning noncoronary cardiac surgery in lieu of cardiac cath; e) detection of coronary anomalies in young persons (<30) with suggestive symptoms. considered experimental for persons with extensive calcification; atrial fib or other significant arrhythmia; inability to image at desired heart rate despite beta blockers; BMI>40, for asymptomatic persons or evaluation of persons at intermediate or high risk
Cigna
Covers 64 slice or greater as adjunct to other testing for the following indications: 1) detection of CAD in symptomatic (ie chest pain) patients if intermediate pre-angiography probability of CAD and ECG uninterpretable or patient unable to exercise; 2) for detection of CAD in symptomatic patients if patient exhibits intermediate pre-angiography probability of CAD and no ECG changes and serial enzymes negative. Also covered for suspected congenital anomalies of coronary circulation or great vessels, suspected peripheral arterial disease independent of # of slices.
Humana
Coverage is limited to devices with slice thickness of 1 mm or less and at least 40 slices per rotation for the following indications: CTA may be used as an alternative to stress echo or stress radionuclide scan in patients who have an equivocal or suspected inaccurate stress EKG (not covered for patients with typical angina and an abnormal stress EKG or stress imaging test). Covered for suspected congenital abnormalities of coronary circulation, to evaluation of chest pain in the ER, and for the assessment of coronary or pulmonary venous anatomy.
United Healthcare
Covered when using machines with 64-slices or greater for the assessment of patients with known or suspected CAD. This includes patients with chest pain syndrome and intermediate pre-angiography probability of CAD when ECG is uninterpretable or patient is unable to exercise; patients with chest pain syndrome and prior uninterpretable or equivocal stress test or patients with acute chest pain and intermediate pre-angiography probability of CAD, no ECG changes and negative serial enzymes. Also covered for assessment of patients with known and suspected coronary anomalies or congenital heart disease. Not covered when using fewer than 64 slice technology or for screening.
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Medicare: Noridian (equipment have collimation of .625 mm or less and a rotational speed of 375 msec or less OR AT LEAST 64 SLICES)
Commerical Payers:
Aetna
Equipment must have 64 slices; considered medically necessary for: a) rule out stenosis for persons with low or very low pre-test risk based on Framingham or ACC criteria with any of the following indications: 1) persons with chest pain who cannot have exercise or pharmacologic stress testing; 2) persons with positive stress test; 3) evaluating chest pain in ER when imaging stress test or angiography are being deferred; b) evaluation of asymptomatic persons at low risk who have equivocal exercise or pharm. stress test; c) pre-op for persons undergoing high risk non cardiac surgery where imaging stress or angiography is being deferred; d) pre-op for planning noncoronary cardiac surgery in lieu of cardiac cath; e) detection of coronary anomalies in young persons (<30) with suggestive symptoms. considered experimental for persons with extensive calcification; atrial fib or other significant arrhythmia; inability to image at desired heart rate despite beta blockers; BMI>40, for asymptomatic persons or evaluation of persons at intermediate or high risk
Cigna
Covers 64 slice or greater as adjunct to other testing for the following indications: 1) detection of CAD in symptomatic (ie chest pain) patients if intermediate pre-angiography probability of CAD and ECG uninterpretable or patient unable to exercise; 2) for detection of CAD in symptomatic patients if patient exhibits intermediate pre-angiography probability of CAD and no ECG changes and serial enzymes negative. Also covered for suspected congenital anomalies of coronary circulation or great vessels, suspected peripheral arterial disease independent of # of slices.
Humana
Coverage is limited to devices with slice thickness of 1 mm or less and at least 40 slices per rotation for the following indications: CTA may be used as an alternative to stress echo or stress radionuclide scan in patients who have an equivocal or suspected inaccurate stress EKG (not covered for patients with typical angina and an abnormal stress EKG or stress imaging test). Covered for suspected congenital abnormalities of coronary circulation, to evaluation of chest pain in the ER, and for the assessment of coronary or pulmonary venous anatomy.
United Healthcare
Covered when using machines with 64-slices or greater for the assessment of patients with known or suspected CAD. This includes patients with chest pain syndrome and intermediate pre-angiography probability of CAD when ECG is uninterpretable or patient is unable to exercise; patients with chest pain syndrome and prior uninterpretable or equivocal stress test or patients with acute chest pain and intermediate pre-angiography probability of CAD, no ECG changes and negative serial enzymes. Also covered for assessment of patients with known and suspected coronary anomalies or congenital heart disease. Not covered when using fewer than 64 slice technology or for screening.
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Medicare: Noridian (equipment have collimation of .625 mm or less and a rotational speed of 375 msec or less OR AT LEAST 64 SLICES)
Commerical Payers:
Aetna
Equipment must have 64 slices; considered medically necessary for: a) rule out stenosis for persons with low or very low pre-test risk based on Framingham or ACC criteria with any of the following indications: 1) persons with chest pain who cannot have exercise or pharmacologic stress testing; 2) persons with positive stress test; 3) evaluating chest pain in ER when imaging stress test or angiography are being deferred; b) evaluation of asymptomatic persons at low risk who have equivocal exercise or pharm. stress test; c) pre-op for persons undergoing high risk non cardiac surgery where imaging stress or angiography is being deferred; d) pre-op for planning noncoronary cardiac surgery in lieu of cardiac cath; e) detection of coronary anomalies in young persons (<30) with suggestive symptoms. considered experimental for persons with extensive calcification; atrial fib or other significant arrhythmia; inability to image at desired heart rate despite beta blockers; BMI>40, for asymptomatic persons or evaluation of persons at intermediate or high risk
Cigna
Covers 64 slice or greater as adjunct to other testing for the following indications: 1) detection of CAD in symptomatic (ie chest pain) patients if intermediate pre-angiography probability of CAD and ECG uninterpretable or patient unable to exercise; 2) for detection of CAD in symptomatic patients if patient exhibits intermediate pre-angiography probability of CAD and no ECG changes and serial enzymes negative. Also covered for suspected congenital anomalies of coronary circulation or great vessels, suspected peripheral arterial disease independent of # of slices.
Humana
Coverage is limited to devices with slice thickness of 1 mm or less and at least 40 slices per rotation for the following indications: CTA may be used as an alternative to stress echo or stress radionuclide scan in patients who have an equivocal or suspected inaccurate stress EKG (not covered for patients with typical angina and an abnormal stress EKG or stress imaging test). Covered for suspected congenital abnormalities of coronary circulation, to evaluation of chest pain in the ER, and for the assessment of coronary or pulmonary venous anatomy.
United Healthcare
Covered when using machines with 64-slices or greater for the assessment of patients with known or suspected CAD. This includes patients with chest pain syndrome and intermediate pre-angiography probability of CAD when ECG is uninterpretable or patient is unable to exercise; patients with chest pain syndrome and prior uninterpretable or equivocal stress test or patients with acute chest pain and intermediate pre-angiography probability of CAD, no ECG changes and negative serial enzymes. Also covered for assessment of patients with known and suspected coronary anomalies or congenital heart disease. Not covered when using fewer than 64 slice technology or for screening.
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Medicare: Noridian (equipment have collimation of .625 mm or less and a rotational speed of 375 msec or less OR AT LEAST 64 SLICES)
Commerical Payers:
Aetna
Equipment must have 64 slices; considered medically necessary for: a) rule out stenosis for persons with low or very low pre-test risk based on Framingham or ACC criteria with any of the following indications: 1) persons with chest pain who cannot have exercise or pharmacologic stress testing; 2) persons with positive stress test; 3) evaluating chest pain in ER when imaging stress test or angiography are being deferred; b) evaluation of asymptomatic persons at low risk who have equivocal exercise or pharm. stress test; c) pre-op for persons undergoing high risk non cardiac surgery where imaging stress or angiography is being deferred; d) pre-op for planning noncoronary cardiac surgery in lieu of cardiac cath; e) detection of coronary anomalies in young persons (<30) with suggestive symptoms. considered experimental for persons with extensive calcification; atrial fib or other significant arrhythmia; inability to image at desired heart rate despite beta blockers; BMI>40, for asymptomatic persons or evaluation of persons at intermediate or high risk
Cigna
Covers 64 slice or greater as adjunct to other testing for the following indications: 1) detection of CAD in symptomatic (ie chest pain) patients if intermediate pre-angiography probability of CAD and ECG uninterpretable or patient unable to exercise; 2) for detection of CAD in symptomatic patients if patient exhibits intermediate pre-angiography probability of CAD and no ECG changes and serial enzymes negative. Also covered for suspected congenital anomalies of coronary circulation or great vessels, suspected peripheral arterial disease independent of # of slices.
Humana
Coverage is limited to devices with slice thickness of 1 mm or less and at least 40 slices per rotation for the following indications: CTA may be used as an alternative to stress echo or stress radionuclide scan in patients who have an equivocal or suspected inaccurate stress EKG (not covered for patients with typical angina and an abnormal stress EKG or stress imaging test). Covered for suspected congenital abnormalities of coronary circulation, to evaluation of chest pain in the ER, and for the assessment of coronary or pulmonary venous anatomy.
United Healthcare
Covered when using machines with 64-slices or greater for the assessment of patients with known or suspected CAD. This includes patients with chest pain syndrome and intermediate pre-angiography probability of CAD when ECG is uninterpretable or patient is unable to exercise; patients with chest pain syndrome and prior uninterpretable or equivocal stress test or patients with acute chest pain and intermediate pre-angiography probability of CAD, no ECG changes and negative serial enzymes. Also covered for assessment of patients with known and suspected coronary anomalies or congenital heart disease. Not covered when using fewer than 64 slice technology or for screening.
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Medicare: Noridian (equipment have collimation of .625 mm or less and a rotational speed of 375 msec or less OR AT LEAST 64 SLICES)
Commerical Payers:
Aetna
Equipment must have 64 slices; considered medically necessary for: a) rule out stenosis for persons with low or very low pre-test risk based on Framingham or ACC criteria with any of the following indications: 1) persons with chest pain who cannot have exercise or pharmacologic stress testing; 2) persons with positive stress test; 3) evaluating chest pain in ER when imaging stress test or angiography are being deferred; b) evaluation of asymptomatic persons at low risk who have equivocal exercise or pharm. stress test; c) pre-op for persons undergoing high risk non cardiac surgery where imaging stress or angiography is being deferred; d) pre-op for planning noncoronary cardiac surgery in lieu of cardiac cath; e) detection of coronary anomalies in young persons (<30) with suggestive symptoms. considered experimental for persons with extensive calcification; atrial fib or other significant arrhythmia; inability to image at desired heart rate despite beta blockers; BMI>40, for asymptomatic persons or evaluation of persons at intermediate or high risk.
Cigna
Covers 64 slice or greater as adjunct to other testing for the following indications: 1) detection of CAD in symptomatic (ie chest pain) patients if intermediate pre-angiography probability of CAD and ECG uninterpretable or patient unable to exercise; 2) for detection of CAD in symptomatic patients if patient exhibits intermediate pre-angiography probability of CAD and no ECG changes and serial enzymes negative. Also covered for suspected congenital anomalies of coronary circulation or great vessels, suspected peripheral arterial disease independent of # of slices.
Humana
Coverage is limited to devices with slice thickness of 1 mm or less and at least 40 slices per rotation for the following indications: CTA may be used as an alternative to stress echo or stress radionuclide scan in patients who have an equivocal or suspected inaccurate stress EKG (not covered for patients with typical angina and an abnormal stress EKG or stress imaging test). Covered for suspected congenital abnormalities of coronary circulation, to evaluation of chest pain in the ER, and for the assessment of coronary or pulmonary venous anatomy.
United Healthcare
Covered when using machines with 64-slices or greater for the assessment of patients with known or suspected CAD. This includes patients with chest pain syndrome and intermediate pre-angiography probability of CAD when ECG is uninterpretable or patient is unable to exercise; patients with chest pain syndrome and prior uninterpretable or equivocal stress test or patients with acute chest pain and intermediate pre-angiography probability of CAD, no ECG changes and negative serial enzymes. Also covered for assessment of patients with known and suspected coronary anomalies or congenital heart disease. Not covered when using fewer than 64 slice technology or for screening.
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Medicare: Noridian (equipment have collimation of .625 mm or less and a rotational speed of 375 msec or less OR AT LEAST 64 SLICES)
Commerical Payers:
Aetna
Equipment must have 64 slices; considered medically necessary for: a) rule out stenosis for persons with low or very low pre-test risk based on Framingham or ACC criteria with any of the following indications: 1) persons with chest pain who cannot have exercise or pharmacologic stress testing; 2) persons with positive stress test; 3) evaluating chest pain in ER when imaging stress test or angiography are being deferred; b) evaluation of asymptomatic persons at low risk who have equivocal exercise or pharm. stress test; c) pre-op for persons undergoing high risk non cardiac surgery where imaging stress or angiography is being deferred; d) pre-op for planning noncoronary cardiac surgery in lieu of cardiac cath; e) detection of coronary anomalies in young persons (<30) with suggestive symptoms. considered experimental for persons with extensive calcification; atrial fib or other significant arrhythmia; inability to image at desired heart rate despite beta blockers; BMI>40, for asymptomatic persons or evaluation of persons at intermediate or high risk.
Cigna
Covers 64 slice or greater as adjunct to other testing for the following indications: 1) detection of CAD in symptomatic (ie chest pain) patients if intermediate pre-angiography probability of CAD and ECG uninterpretable or patient unable to exercise; 2) for detection of CAD in symptomatic patients if patient exhibits intermediate pre-angiography probability of CAD and no ECG changes and serial enzymes negative. Also covered for suspected congenital anomalies of coronary circulation or great vessels, suspected peripheral arterial disease independent of # of slices.
Humana
Coverage is limited to devices with slice thickness of 1 mm or less and at least 40 slices per rotation for the following indications: CTA may be used as an alternative to stress echo or stress radionuclide scan in patients who have an equivocal or suspected inaccurate stress EKG (not covered for patients with typical angina and an abnormal stress EKG or stress imaging test). Covered for suspected congenital abnormalities of coronary circulation, to evaluation of chest pain in the ER, and for the assessment of coronary or pulmonary venous anatomy.
United Healthcare
Covered when using machines with 64-slices or greater for the assessment of patients with known or suspected CAD. This includes patients with chest pain syndrome and intermediate pre-angiography probability of CAD when ECG is uninterpretable or patient is unable to exercise; patients with chest pain syndrome and prior uninterpretable or equivocal stress test or patients with acute chest pain and intermediate pre-angiography probability of CAD, no ECG changes and negative serial enzymes. Also covered for assessment of patients with known and suspected coronary anomalies or congenital heart disease. Not covered when using fewer than 64 slice technology or for screening.
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Medicare: Noridian (equipment have collimation of .625 mm or less and a rotational speed of 375 msec or less OR AT LEAST 64 SLICES)
Commerical Payers:
Aetna
Equipment must have 64 slices; considered medically necessary for: a) rule out stenosis for persons with low or very low pre-test risk based on Framingham or ACC criteria with any of the following indications: 1) persons with chest pain who cannot have exercise or pharmacologic stress testing; 2) persons with positive stress test; 3) evaluating chest pain in ER when imaging stress test or angiography are being deferred; b) evaluation of asymptomatic persons at low risk who have equivocal exercise or pharm. stress test; c) pre-op for persons undergoing high risk non cardiac surgery where imaging stress or angiography is being deferred; d) pre-op for planning noncoronary cardiac surgery in lieu of cardiac cath; e) detection of coronary anomalies in young persons (<30) with suggestive symptoms. considered experimental for persons with extensive calcification; atrial fib or other significant arrhythmia; inability to image at desired heart rate despite beta blockers; BMI>40, for asymptomatic persons or evaluation of persons at intermediate or high risk
Cigna
Covers 64 slice or greater as adjunct to other testing for the following indications: 1) detection of CAD in symptomatic (ie chest pain) patients if intermediate pre-angiography probability of CAD and ECG uninterpretable or patient unable to exercise; 2) for detection of CAD in symptomatic patients if patient exhibits intermediate pre-angiography probability of CAD and no ECG changes and serial enzymes negative. Also covered for suspected congenital anomalies of coronary circulation or great vessels, suspected peripheral arterial disease independent of # of slices.
Humana
Coverage is limited to devices with slice thickness of 1 mm or less and at least 40 slices per rotation for the following indications: CTA may be used as an alternative to stress echo or stress radionuclide scan in patients who have an equivocal or suspected inaccurate stress EKG (not covered for patients with typical angina and an abnormal stress EKG or stress imaging test). Covered for suspected congenital abnormalities of coronary circulation, to evaluation of chest pain in the ER, and for the assessment of coronary or pulmonary venous anatomy.
United Healthcare
Covered when using machines with 64-slices or greater for the assessment of patients with known or suspected CAD. This includes patients with chest pain syndrome and intermediate pre-angiography probability of CAD when ECG is uninterpretable or patient is unable to exercise; patients with chest pain syndrome and prior uninterpretable or equivocal stress test or patients with acute chest pain and intermediate pre-angiography probability of CAD, no ECG changes and negative serial enzymes. Also covered for assessment of patients with known and suspected coronary anomalies or congenital heart disease. Not covered when using fewer than 64 slice technology or for screening.
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Medicare: Noridian (equipment have collimation of .625 mm or less and a rotational speed of 375 msec or less OR AT LEAST 64 SLICES)
Commerical Payers:
Aetna
Equipment must have 64 slices; considered medically necessary for: a) rule out stenosis for persons with low or very low pre-test risk based on Framingham or ACC criteria with any of the following indications: 1) persons with chest pain who cannot have exercise or pharmacologic stress testing; 2) persons with positive stress test; 3) evaluating chest pain in ER when imaging stress test or angiography are being deferred; b) evaluation of asymptomatic persons at low risk who have equivocal exercise or pharm. stress test; c) pre-op for persons undergoing high risk non cardiac surgery where imaging stress or angiography is being deferred; d) pre-op for planning noncoronary cardiac surgery in lieu of cardiac cath; e) detection of coronary anomalies in young persons (<30) with suggestive symptoms. considered experimental for persons with extensive calcification; atrial fib or other significant arrhythmia; inability to image at desired heart rate despite beta blockers; BMI>40, for asymptomatic persons or evaluation of persons at intermediate or high risk.
Cigna
Covers 64 slice or greater as adjunct to other testing for the following indications: 1) detection of CAD in symptomatic (ie chest pain) patients if intermediate pre-angiography probability of CAD and ECG uninterpretable or patient unable to exercise; 2) for detection of CAD in symptomatic patients if patient exhibits intermediate pre-angiography probability of CAD and no ECG changes and serial enzymes negative. Also covered for suspected congenital anomalies of coronary circulation or great vessels, suspected peripheral arterial disease independent of # of slices.
Humana
Coverage is limited to devices with slice thickness of 1 mm or less and at least 40 slices per rotation for the following indications: CTA may be used as an alternative to stress echo or stress radionuclide scan in patients who have an equivocal or suspected inaccurate stress EKG (not covered for patients with typical angina and an abnormal stress EKG or stress imaging test). Covered for suspected congenital abnormalities of coronary circulation, to evaluation of chest pain in the ER, and for the assessment of coronary or pulmonary venous anatomy.
United Healthcare
Covered when using machines with 64-slices or greater for the assessment of patients with known or suspected CAD. This includes patients with chest pain syndrome and intermediate pre-angiography probability of CAD when ECG is uninterpretable or patient is unable to exercise; patients with chest pain syndrome and prior uninterpretable or equivocal stress test or patients with acute chest pain and intermediate pre-angiography probability of CAD, no ECG changes and negative serial enzymes. Also covered for assessment of patients with known and suspected coronary anomalies or congenital heart disease. Not covered when using fewer than 64 slice technology or for screening.
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Medicare: Noridian (equipment have collimation of .625 mm or less and a rotational speed of 375 msec or less OR AT LEAST 64 SLICES)
Commerical Payers:
Aetna
Equipment must have 64 slices; considered medically necessary for: a) rule out stenosis for persons with low or very low pre-test risk based on Framingham or ACC criteria with any of the following indications: 1) persons with chest pain who cannot have exercise or pharmacologic stress testing; 2) persons with positive stress test; 3) evaluating chest pain in ER when imaging stress test or angiography are being deferred; b) evaluation of asymptomatic persons at low risk who have equivocal exercise or pharm. stress test; c) pre-op for persons undergoing high risk non cardiac surgery where imaging stress or angiography is being deferred; d) pre-op for planning noncoronary cardiac surgery in lieu of cardiac cath; e) detection of coronary anomalies in young persons (<30) with suggestive symptoms. considered experimental for persons with extensive calcification; atrial fib or other significant arrhythmia; inability to image at desired heart rate despite beta blockers; BMI>40, for asymptomatic persons or evaluation of persons at intermediate or high risk.
Cigna
Covers 64 slice or greater as adjunct to other testing for the following indications: 1) detection of CAD in symptomatic (ie chest pain) patients if intermediate pre-angiography probability of CAD and ECG uninterpretable or patient unable to exercise; 2) for detection of CAD in symptomatic patients if patient exhibits intermediate pre-angiography probability of CAD and no ECG changes and serial enzymes negative. Also covered for suspected congenital anomalies of coronary circulation or great vessels, suspected peripheral arterial disease independent of # of slices.
Humana
Coverage is limited to devices with slice thickness of 1 mm or less and at least 40 slices per rotation for the following indications: CTA may be used as an alternative to stress echo or stress radionuclide scan in patients who have an equivocal or suspected inaccurate stress EKG (not covered for patients with typical angina and an abnormal stress EKG or stress imaging test). Covered for suspected congenital abnormalities of coronary circulation, to evaluation of chest pain in the ER, and for the assessment of coronary or pulmonary venous anatomy.
United Healthcare
Covered when using machines with 64-slices or greater for the assessment of patients with known or suspected CAD. This includes patients with chest pain syndrome and intermediate pre-angiography probability of CAD when ECG is uninterpretable or patient is unable to exercise; patients with chest pain syndrome and prior uninterpretable or equivocal stress test or patients with acute chest pain and intermediate pre-angiography probability of CAD, no ECG changes and negative serial enzymes. Also covered for assessment of patients with known and suspected coronary anomalies or congenital heart disease. Not covered when using fewer than 64 slice technology or for screening.
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Medicare: Noridian (equipment have collimation of .625 mm or less and a rotational speed of 375 msec or less OR AT LEAST 64 SLICES)
Commerical Payers:
Aetna
Equipment must have 64 slices; considered medically necessary for: a) rule out stenosis for persons with low or very low pre-test risk based on Framingham or ACC criteria with any of the following indications: 1) persons with chest pain who cannot have exercise or pharmacologic stress testing; 2) persons with positive stress test; 3) evaluating chest pain in ER when imaging stress test or angiography are being deferred; b) evaluation of asymptomatic persons at low risk who have equivocal exercise or pharm. stress test; c) pre-op for persons undergoing high risk non cardiac surgery where imaging stress or angiography is being deferred; d) pre-op for planning noncoronary cardiac surgery in lieu of cardiac cath; e) detection of coronary anomalies in young persons (<30) with suggestive symptoms. considered experimental for persons with extensive calcification; atrial fib or other significant arrhythmia; inability to image at desired heart rate despite beta blockers; BMI>40, for asymptomatic persons or evaluation of persons at intermediate or high risk
Cigna
Covers 64 slice or greater as adjunct to other testing for the following indications: 1) detection of CAD in symptomatic (ie chest pain) patients if intermediate pre-angiography probability of CAD and ECG uninterpretable or patient unable to exercise; 2) for detection of CAD in symptomatic patients if patient exhibits intermediate pre-angiography probability of CAD and no ECG changes and serial enzymes negative. Also covered for suspected congenital anomalies of coronary circulation or great vessels, suspected peripheral arterial disease independent of # of slices.
Humana
Coverage is limited to devices with slice thickness of 1 mm or less and at least 40 slices per rotation for the following indications: CTA may be used as an alternative to stress echo or stress radionuclide scan in patients who have an equivocal or suspected inaccurate stress EKG (not covered for patients with typical angina and an abnormal stress EKG or stress imaging test). Covered for suspected congenital abnormalities of coronary circulation, to evaluation of chest pain in the ER, and for the assessment of coronary or pulmonary venous anatomy.
United Healthcare
Covered when using machines with 64-slices or greater for the assessment of patients with known or suspected CAD. This includes patients with chest pain syndrome and intermediate pre-angiography probability of CAD when ECG is uninterpretable or patient is unable to exercise; patients with chest pain syndrome and prior uninterpretable or equivocal stress test or patients with acute chest pain and intermediate pre-angiography probability of CAD, no ECG changes and negative serial enzymes. Also covered for assessment of patients with known and suspected coronary anomalies or congenital heart disease. Not covered when using fewer than 64 slice technology or for screening.
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Medicare: Noridian (equipment have collimation of .625 mm or less and a rotational speed of 375 msec or less OR AT LEAST 64 SLICES)
Commerical Payers:
Aetna
Equipment must have 64 slices; considered medically necessary for: a) rule out stenosis for persons with low or very low pre-test risk based on Framingham or ACC criteria with any of the following indications: 1) persons with chest pain who cannot have exercise or pharmacologic stress testing; 2) persons with positive stress test; 3) evaluating chest pain in ER when imaging stress test or angiography are being deferred; b) evaluation of asymptomatic persons at low risk who have equivocal exercise or pharm. stress test; c) pre-op for persons undergoing high risk non cardiac surgery where imaging stress or angiography is being deferred; d) pre-op for planning noncoronary cardiac surgery in lieu of cardiac cath; e) detection of coronary anomalies in young persons (<30) with suggestive symptoms. considered experimental for persons with extensive calcification; atrial fib or other significant arrhythmia; inability to image at desired heart rate despite beta blockers; BMI>40, for asymptomatic persons or evaluation of persons at intermediate or high risk.
Cigna
Covers 64 slice or greater as adjunct to other testing for the following indications: 1) detection of CAD in symptomatic (ie chest pain) patients if intermediate pre-angiography probability of CAD and ECG uninterpretable or patient unable to exercise; 2) for detection of CAD in symptomatic patients if patient exhibits intermediate pre-angiography probability of CAD and no ECG changes and serial enzymes negative. Also covered for suspected congenital anomalies of coronary circulation or great vessels, suspected peripheral arterial disease independent of # of slices.
Humana
Coverage is limited to devices with slice thickness of 1 mm or less and at least 40 slices per rotation for the following indications: CTA may be used as an alternative to stress echo or stress radionuclide scan in patients who have an equivocal or suspected inaccurate stress EKG (not covered for patients with typical angina and an abnormal stress EKG or stress imaging test). Covered for suspected congenital abnormalities of coronary circulation, to evaluation of chest pain in the ER, and for the assessment of coronary or pulmonary venous anatomy.
United Healthcare
Covered when using machines with 64-slices or greater for the assessment of patients with known or suspected CAD. This includes patients with chest pain syndrome and intermediate pre-angiography probability of CAD when ECG is uninterpretable or patient is unable to exercise; patients with chest pain syndrome and prior uninterpretable or equivocal stress test or patients with acute chest pain and intermediate pre-angiography probability of CAD, no ECG changes and negative serial enzymes. Also covered for assessment of patients with known and suspected coronary anomalies or congenital heart disease. Not covered when using fewer than 64 slice technology or for screening.
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Medicare: Noridian (equipment have collimation of .625 mm or less and a rotational speed of 375 msec or less OR AT LEAST 64 SLICES)
Commerical Payers:
Aetna
Equipment must have 64 slices; considered medically necessary for: a) rule out stenosis for persons with low or very low pre-test risk based on Framingham or ACC criteria with any of the following indications: 1) persons with chest pain who cannot have exercise or pharmacologic stress testing; 2) persons with positive stress test; 3) evaluating chest pain in ER when imaging stress test or angiography are being deferred; b) evaluation of asymptomatic persons at low risk who have equivocal exercise or pharm. stress test; c) pre-op for persons undergoing high risk non cardiac surgery where imaging stress or angiography is being deferred; d) pre-op for planning noncoronary cardiac surgery in lieu of cardiac cath; e) detection of coronary anomalies in young persons (<30) with suggestive symptoms. considered experimental for persons with extensive calcification; atrial fib or other significant arrhythmia; inability to image at desired heart rate despite beta blockers; BMI>40, for asymptomatic persons or evaluation of persons at intermediate or high risk
Cigna
Covers 64 slice or greater as adjunct to other testing for the following indications: 1) detection of CAD in symptomatic (ie chest pain) patients if intermediate pre-angiography probability of CAD and ECG uninterpretable or patient unable to exercise; 2) for detection of CAD in symptomatic patients if patient exhibits intermediate pre-angiography probability of CAD and no ECG changes and serial enzymes negative. Also covered for suspected congenital anomalies of coronary circulation or great vessels, suspected peripheral arterial disease independent of # of slices.
Humana
Coverage is limited to devices with slice thickness of 1 mm or less and at least 40 slices per rotation for the following indications: CTA may be used as an alternative to stress echo or stress radionuclide scan in patients who have an equivocal or suspected inaccurate stress EKG (not covered for patients with typical angina and an abnormal stress EKG or stress imaging test). Covered for suspected congenital abnormalities of coronary circulation, to evaluation of chest pain in the ER, and for the assessment of coronary or pulmonary venous anatomy.
United Healthcare
Covered when using machines with 64-slices or greater for the assessment of patients with known or suspected CAD. This includes patients with chest pain syndrome and intermediate pre-angiography probability of CAD when ECG is uninterpretable or patient is unable to exercise; patients with chest pain syndrome and prior uninterpretable or equivocal stress test or patients with acute chest pain and intermediate pre-angiography probability of CAD, no ECG changes and negative serial enzymes. Also covered for assessment of patients with known and suspected coronary anomalies or congenital heart disease. Not covered when using fewer than 64 slice technology or for screening.
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Medicare: Noridian (equipment have collimation of .625 mm or less and a rotational speed of 375 msec or less OR AT LEAST 64 SLICES)
Commerical Payers:
Aetna
Equipment must have 64 slices; considered medically necessary for: a) rule out stenosis for persons with low or very low pre-test risk based on Framingham or ACC criteria with any of the following indications: 1) persons with chest pain who cannot have exercise or pharmacologic stress testing; 2) persons with positive stress test; 3) evaluating chest pain in ER when imaging stress test or angiography are being deferred; b) evaluation of asymptomatic persons at low risk who have equivocal exercise or pharm. stress test; c) pre-op for persons undergoing high risk non cardiac surgery where imaging stress or angiography is being deferred; d) pre-op for planning noncoronary cardiac surgery in lieu of cardiac cath; e) detection of coronary anomalies in young persons (<30) with suggestive symptoms. considered experimental for persons with extensive calcification; atrial fib or other significant arrhythmia; inability to image at desired heart rate despite beta blockers; BMI>40, for asymptomatic persons or evaluation of persons at intermediate or high risk.
Cigna
Covers 64 slice or greater as adjunct to other testing for the following indications: 1) detection of CAD in symptomatic (ie chest pain) patients if intermediate pre-angiography probability of CAD and ECG uninterpretable or patient unable to exercise; 2) for detection of CAD in symptomatic patients if patient exhibits intermediate pre-angiography probability of CAD and no ECG changes and serial enzymes negative. Also covered for suspected congenital anomalies of coronary circulation or great vessels, suspected peripheral arterial disease independent of # of slices.
Humana
Coverage is limited to devices with slice thickness of 1 mm or less and at least 40 slices per rotation for the following indications: CTA may be used as an alternative to stress echo or stress radionuclide scan in patients who have an equivocal or suspected inaccurate stress EKG (not covered for patients with typical angina and an abnormal stress EKG or stress imaging test). Covered for suspected congenital abnormalities of coronary circulation, to evaluation of chest pain in the ER, and for the assessment of coronary or pulmonary venous anatomy.
United Healthcare
Covered when using machines with 64-slices or greater for the assessment of patients with known or suspected CAD. This includes patients with chest pain syndrome and intermediate pre-angiography probability of CAD when ECG is uninterpretable or patient is unable to exercise; patients with chest pain syndrome and prior uninterpretable or equivocal stress test or patients with acute chest pain and intermediate pre-angiography probability of CAD, no ECG changes and negative serial enzymes. Also covered for assessment of patients with known and suspected coronary anomalies or congenital heart disease. Not covered when using fewer than 64 slice technology or for screening
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Medicare: Noridian (equipment have collimation of .625 mm or less and a rotational speed of 375 msec or less OR AT LEAST 64 SLICES)
Commerical Payers:
Aetna
Equipment must have 64 slices; considered medically necessary for: a) rule out stenosis for persons with low or very low pre-test risk based on Framingham or ACC criteria with any of the following indications: 1) persons with chest pain who cannot have exercise or pharmacologic stress testing; 2) persons with positive stress test; 3) evaluating chest pain in ER when imaging stress test or angiography are being deferred; b) evaluation of asymptomatic persons at low risk who have equivocal exercise or pharm. stress test; c) pre-op for persons undergoing high risk non cardiac surgery where imaging stress or angiography is being deferred; d) pre-op for planning noncoronary cardiac surgery in lieu of cardiac cath; e) detection of coronary anomalies in young persons (<30) with suggestive symptoms. considered experimental for persons with extensive calcification; atrial fib or other significant arrhythmia; inability to image at desired heart rate despite beta blockers; BMI>40, for asymptomatic persons or evaluation of persons at intermediate or high risk
Cigna
Covers 64 slice or greater as adjunct to other testing for the following indications: 1) detection of CAD in symptomatic (ie chest pain) patients if intermediate pre-angiography probability of CAD and ECG uninterpretable or patient unable to exercise; 2) for detection of CAD in symptomatic patients if patient exhibits intermediate pre-angiography probability of CAD and no ECG changes and serial enzymes negative. Also covered for suspected congenital anomalies of coronary circulation or great vessels, suspected peripheral arterial disease independent of # of slices.
Humana
Coverage is limited to devices with slice thickness of 1 mm or less and at least 40 slices per rotation for the following indications: CTA may be used as an alternative to stress echo or stress radionuclide scan in patients who have an equivocal or suspected inaccurate stress EKG (not covered for patients with typical angina and an abnormal stress EKG or stress imaging test). Covered for suspected congenital abnormalities of coronary circulation, to evaluation of chest pain in the ER, and for the assessment of coronary or pulmonary venous anatomy.
United Healthcare
Covered when using machines with 64-slices or greater for the assessment of patients with known or suspected CAD. This includes patients with chest pain syndrome and intermediate pre-angiography probability of CAD when ECG is uninterpretable or patient is unable to exercise; patients with chest pain syndrome and prior uninterpretable or equivocal stress test or patients with acute chest pain and intermediate pre-angiography probability of CAD, no ECG changes and negative serial enzymes. Also covered for assessment of patients with known and suspected coronary anomalies or congenital heart disease. Not covered when using fewer than 64 slice technology or for screening.
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Medicare: Noridian (equipment have collimation of .625 mm or less and a rotational speed of 375 msec or less OR AT LEAST 64 SLICES)
Commerical Payers:
Aetna
Equipment must have 64 slices; considered medically necessary for: a) rule out stenosis for persons with low or very low pre-test risk based on Framingham or ACC criteria with any of the following indications: 1) persons with chest pain who cannot have exercise or pharmacologic stress testing; 2) persons with positive stress test; 3) evaluating chest pain in ER when imaging stress test or angiography are being deferred; b) evaluation of asymptomatic persons at low risk who have equivocal exercise or pharm. stress test; c) pre-op for persons undergoing high risk non cardiac surgery where imaging stress or angiography is being deferred; d) pre-op for planning noncoronary cardiac surgery in lieu of cardiac cath; e) detection of coronary anomalies in young persons (<30) with suggestive symptoms. considered experimental for persons with extensive calcification; atrial fib or other significant arrhythmia; inability to image at desired heart rate despite beta blockers; BMI>40, for asymptomatic persons or evaluation of persons at intermediate or high risk.
Cigna
Covers 64 slice or greater as adjunct to other testing for the following indications: 1) detection of CAD in symptomatic (ie chest pain) patients if intermediate pre-angiography probability of CAD and ECG uninterpretable or patient unable to exercise; 2) for detection of CAD in symptomatic patients if patient exhibits intermediate pre-angiography probability of CAD and no ECG changes and serial enzymes negative. Also covered for suspected congenital anomalies of coronary circulation or great vessels, suspected peripheral arterial disease independent of # of slices.
Humana
Coverage is limited to devices with slice thickness of 1 mm or less and at least 40 slices per rotation for the following indications: CTA may be used as an alternative to stress echo or stress radionuclide scan in patients who have an equivocal or suspected inaccurate stress EKG (not covered for patients with typical angina and an abnormal stress EKG or stress imaging test). Covered for suspected congenital abnormalities of coronary circulation, to evaluation of chest pain in the ER, and for the assessment of coronary or pulmonary venous anatomy.
United Healthcare
Covered when using machines with 64-slices or greater for the assessment of patients with known or suspected CAD. This includes patients with chest pain syndrome and intermediate pre-angiography probability of CAD when ECG is uninterpretable or patient is unable to exercise; patients with chest pain syndrome and prior uninterpretable or equivocal stress test or patients with acute chest pain and intermediate pre-angiography probability of CAD, no ECG changes and negative serial enzymes. Also covered for assessment of patients with known and suspected coronary anomalies or congenital heart disease. Not covered when using fewer than 64 slice technology or for screening.
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Medicare: Noridian (equipment have collimation of .625 mm or less and a rotational speed of 375 msec or less OR AT LEAST 64 SLICES)
Commerical Payers:
Aetna
Equipment must have 64 slices; considered medically necessary for: a) rule out stenosis for persons with low or very low pre-test risk based on Framingham or ACC criteria with any of the following indications: 1) persons with chest pain who cannot have exercise or pharmacologic stress testing; 2) persons with positive stress test; 3) evaluating chest pain in ER when imaging stress test or angiography are being deferred; b) evaluation of asymptomatic persons at low risk who have equivocal exercise or pharm. stress test; c) pre-op for persons undergoing high risk non cardiac surgery where imaging stress or angiography is being deferred; d) pre-op for planning noncoronary cardiac surgery in lieu of cardiac cath; e) detection of coronary anomalies in young persons (<30) with suggestive symptoms. considered experimental for persons with extensive calcification; atrial fib or other significant arrhythmia; inability to image at desired heart rate despite beta blockers; BMI>40, for asymptomatic persons or evaluation of persons at intermediate or high risk
Cigna
Covers 64 slice or greater as adjunct to other testing for the following indications: 1) detection of CAD in symptomatic (ie chest pain) patients if intermediate pre-angiography probability of CAD and ECG uninterpretable or patient unable to exercise; 2) for detection of CAD in symptomatic patients if patient exhibits intermediate pre-angiography probability of CAD and no ECG changes and serial enzymes negative. Also covered for suspected congenital anomalies of coronary circulation or great vessels, suspected peripheral arterial disease independent of # of slices.
Humana
Coverage is limited to devices with slice thickness of 1 mm or less and at least 40 slices per rotation for the following indications: CTA may be used as an alternative to stress echo or stress radionuclide scan in patients who have an equivocal or suspected inaccurate stress EKG (not covered for patients with typical angina and an abnormal stress EKG or stress imaging test). Covered for suspected congenital abnormalities of coronary circulation, to evaluation of chest pain in the ER, and for the assessment of coronary or pulmonary venous anatomy.
United Healthcare
Covered when using machines with 64-slices or greater for the assessment of patients with known or suspected CAD. This includes patients with chest pain syndrome and intermediate pre-angiography probability of CAD when ECG is uninterpretable or patient is unable to exercise; patients with chest pain syndrome and prior uninterpretable or equivocal stress test or patients with acute chest pain and intermediate pre-angiography probability of CAD, no ECG changes and negative serial enzymes. Also covered for assessment of patients with known and suspected coronary anomalies or congenital heart disease. Not covered when using fewer than 64 slice technology or for screening.
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Medicare: Noridian (equipment have collimation of .625 mm or less and a rotational speed of 375 msec or less OR AT LEAST 64 SLICES)
Commerical Payers:
Aetna
Equipment must have 64 slices; considered medically necessary for: a) rule out stenosis for persons with low or very low pre-test risk based on Framingham or ACC criteria with any of the following indications: 1) persons with chest pain who cannot have exercise or pharmacologic stress testing; 2) persons with positive stress test; 3) evaluating chest pain in ER when imaging stress test or angiography are being deferred; b) evaluation of asymptomatic persons at low risk who have equivocal exercise or pharm. stress test; c) pre-op for persons undergoing high risk non cardiac surgery where imaging stress or angiography is being deferred; d) pre-op for planning noncoronary cardiac surgery in lieu of cardiac cath; e) detection of coronary anomalies in young persons (<30) with suggestive symptoms. considered experimental for persons with extensive calcification; atrial fib or other significant arrhythmia; inability to image at desired heart rate despite beta blockers; BMI>40, for asymptomatic persons or evaluation of persons at intermediate or high risk.
Cigna
Covers 64 slice or greater as adjunct to other testing for the following indications: 1) detection of CAD in symptomatic (ie chest pain) patients if intermediate pre-angiography probability of CAD and ECG uninterpretable or patient unable to exercise; 2) for detection of CAD in symptomatic patients if patient exhibits intermediate pre-angiography probability of CAD and no ECG changes and serial enzymes negative. Also covered for suspected congenital anomalies of coronary circulation or great vessels, suspected peripheral arterial disease independent of # of slices.
Humana
Coverage is limited to devices with slice thickness of 1 mm or less and at least 40 slices per rotation for the following indications: CTA may be used as an alternative to stress echo or stress radionuclide scan in patients who have an equivocal or suspected inaccurate stress EKG (not covered for patients with typical angina and an abnormal stress EKG or stress imaging test). Covered for suspected congenital abnormalities of coronary circulation, to evaluation of chest pain in the ER, and for the assessment of coronary or pulmonary venous anatomy.
United Healthcare
Covered when using machines with 64-slices or greater for the assessment of patients with known or suspected CAD. This includes patients with chest pain syndrome and intermediate pre-angiography probability of CAD when ECG is uninterpretable or patient is unable to exercise; patients with chest pain syndrome and prior uninterpretable or equivocal stress test or patients with acute chest pain and intermediate pre-angiography probability of CAD, no ECG changes and negative serial enzymes. Also covered for assessment of patients with known and suspected coronary anomalies or congenital heart disease. Not covered when using fewer than 64 slice technology or for screening.
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Medicare: Noridian (equipment have collimation of .625 mm or less and a rotational speed of 375 msec or less OR AT LEAST 64 SLICES)
Commerical Payers:
Aetna
Equipment must have 64 slices; considered medically necessary for: a) rule out stenosis for persons with low or very low pre-test risk based on Framingham or ACC criteria with any of the following indications: 1) persons with chest pain who cannot have exercise or pharmacologic stress testing; 2) persons with positive stress test; 3) evaluating chest pain in ER when imaging stress test or angiography are being deferred; b) evaluation of asymptomatic persons at low risk who have equivocal exercise or pharm. stress test; c) pre-op for persons undergoing high risk non cardiac surgery where imaging stress or angiography is being deferred; d) pre-op for planning noncoronary cardiac surgery in lieu of cardiac cath; e) detection of coronary anomalies in young persons (<30) with suggestive symptoms. considered experimental for persons with extensive calcification; atrial fib or other significant arrhythmia; inability to image at desired heart rate despite beta blockers; BMI>40, for asymptomatic persons or evaluation of persons at intermediate or high risk
Cigna
Covers 64 slice or greater as adjunct to other testing for the following indications: 1) detection of CAD in symptomatic (ie chest pain) patients if intermediate pre-angiography probability of CAD and ECG uninterpretable or patient unable to exercise; 2) for detection of CAD in symptomatic patients if patient exhibits intermediate pre-angiography probability of CAD and no ECG changes and serial enzymes negative. Also covered for suspected congenital anomalies of coronary circulation or great vessels, suspected peripheral arterial disease independent of # of slices.
Humana
Coverage is limited to devices with slice thickness of 1 mm or less and at least 40 slices per rotation for the following indications: CTA may be used as an alternative to stress echo or stress radionuclide scan in patients who have an equivocal or suspected inaccurate stress EKG (not covered for patients with typical angina and an abnormal stress EKG or stress imaging test). Covered for suspected congenital abnormalities of coronary circulation, to evaluation of chest pain in the ER, and for the assessment of coronary or pulmonary venous anatomy.
United Healthcare
Covered when using machines with 64-slices or greater for the assessment of patients with known or suspected CAD. This includes patients with chest pain syndrome and intermediate pre-angiography probability of CAD when ECG is uninterpretable or patient is unable to exercise; patients with chest pain syndrome and prior uninterpretable or equivocal stress test or patients with acute chest pain and intermediate pre-angiography probability of CAD, no ECG changes and negative serial enzymes. Also covered for assessment of patients with known and suspected coronary anomalies or congenital heart disease. Not covered when using fewer than 64 slice technology or for screening.
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Medicare: Noridian (equipment have collimation of .625 mm or less and a rotational speed of 375 msec or less OR AT LEAST 64 SLICES)
Commerical Payers:
Aetna
Equipment must have 64 slices; considered medically necessary for: a) rule out stenosis for persons with low or very low pre-test risk based on Framingham or ACC criteria with any of the following indications: 1) persons with chest pain who cannot have exercise or pharmacologic stress testing; 2) persons with positive stress test; 3) evaluating chest pain in ER when imaging stress test or angiography are being deferred; b) evaluation of asymptomatic persons at low risk who have equivocal exercise or pharm. stress test; c) pre-op for persons undergoing high risk non cardiac surgery where imaging stress or angiography is being deferred; d) pre-op for planning noncoronary cardiac surgery in lieu of cardiac cath; e) detection of coronary anomalies in young persons (<30) with suggestive symptoms. considered experimental for persons with extensive calcification; atrial fib or other significant arrhythmia; inability to image at desired heart rate despite beta blockers; BMI>40, for asymptomatic persons or evaluation of persons at intermediate or high risk
Cigna
Covers 64 slice or greater as adjunct to other testing for the following indications: 1) detection of CAD in symptomatic (ie chest pain) patients if intermediate pre-angiography probability of CAD and ECG uninterpretable or patient unable to exercise; 2) for detection of CAD in symptomatic patients if patient exhibits intermediate pre-angiography probability of CAD and no ECG changes and serial enzymes negative. Also covered for suspected congenital anomalies of coronary circulation or great vessels, suspected peripheral arterial disease independent of # of slices.
Humana
Coverage is limited to devices with slice thickness of 1 mm or less and at least 40 slices per rotation for the following indications: CTA may be used as an alternative to stress echo or stress radionuclide scan in patients who have an equivocal or suspected inaccurate stress EKG (not covered for patients with typical angina and an abnormal stress EKG or stress imaging test). Covered for suspected congenital abnormalities of coronary circulation, to evaluation of chest pain in the ER, and for the assessment of coronary or pulmonary venous anatomy.
United Healthcare
Covered when using machines with 64-slices or greater for the assessment of patients with known or suspected CAD. This includes patients with chest pain syndrome and intermediate pre-angiography probability of CAD when ECG is uninterpretable or patient is unable to exercise; patients with chest pain syndrome and prior uninterpretable or equivocal stress test or patients with acute chest pain and intermediate pre-angiography probability of CAD, no ECG changes and negative serial enzymes. Also covered for assessment of patients with known and suspected coronary anomalies or congenital heart disease. Not covered when using fewer than 64 slice technology or for screening.
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Medicare: Noridian (equipment have collimation of .625 mm or less and a rotational speed of 375 msec or less OR AT LEAST 64 SLICES)
Commerical Payers:
Aetna
Equipment must have 64 slices; considered medically necessary for: a) rule out stenosis for persons with low or very low pre-test risk based on Framingham or ACC criteria with any of the following indications: 1) persons with chest pain who cannot have exercise or pharmacologic stress testing; 2) persons with positive stress test; 3) evaluating chest pain in ER when imaging stress test or angiography are being deferred; b) evaluation of asymptomatic persons at low risk who have equivocal exercise or pharm. stress test; c) pre-op for persons undergoing high risk non cardiac surgery where imaging stress or angiography is being deferred; d) pre-op for planning noncoronary cardiac surgery in lieu of cardiac cath; e) detection of coronary anomalies in young persons (<30) with suggestive symptoms. considered experimental for persons with extensive calcification; atrial fib or other significant arrhythmia; inability to image at desired heart rate despite beta blockers; BMI>40, for asymptomatic persons or evaluation of persons at intermediate or high risk
Cigna
Covers 64 slice or greater as adjunct to other testing for the following indications: 1) detection of CAD in symptomatic (ie chest pain) patients if intermediate pre-angiography probability of CAD and ECG uninterpretable or patient unable to exercise; 2) for detection of CAD in symptomatic patients if patient exhibits intermediate pre-angiography probability of CAD and no ECG changes and serial enzymes negative. Also covered for suspected congenital anomalies of coronary circulation or great vessels, suspected peripheral arterial disease independent of # of slices.
Humana
Coverage is limited to devices with slice thickness of 1 mm or less and at least 40 slices per rotation for the following indications: CTA may be used as an alternative to stress echo or stress radionuclide scan in patients who have an equivocal or suspected inaccurate stress EKG (not covered for patients with typical angina and an abnormal stress EKG or stress imaging test). Covered for suspected congenital abnormalities of coronary circulation, to evaluation of chest pain in the ER, and for the assessment of coronary or pulmonary venous anatomy.
United Healthcare
Covered when using machines with 64-slices or greater for the assessment of patients with known or suspected CAD. This includes patients with chest pain syndrome and intermediate pre-angiography probability of CAD when ECG is uninterpretable or patient is unable to exercise; patients with chest pain syndrome and prior uninterpretable or equivocal stress test or patients with acute chest pain and intermediate pre-angiography probability of CAD, no ECG changes and negative serial enzymes. Also covered for assessment of patients with known and suspected coronary anomalies or congenital heart disease. Not covered when using fewer than 64 slice technology or for screening.
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Medicare: Noridian (equipment have collimation of .625 mm or less and a rotational speed of 375 msec or less OR AT LEAST 64 SLICES)
Commerical Payers:
Aetna
Equipment must have 64 slices; considered medically necessary for: a) rule out stenosis for persons with low or very low pre-test risk based on Framingham or ACC criteria with any of the following indications: 1) persons with chest pain who cannot have exercise or pharmacologic stress testing; 2) persons with positive stress test; 3) evaluating chest pain in ER when imaging stress test or angiography are being deferred; b) evaluation of asymptomatic persons at low risk who have equivocal exercise or pharm. stress test; c) pre-op for persons undergoing high risk non cardiac surgery where imaging stress or angiography is being deferred; d) pre-op for planning noncoronary cardiac surgery in lieu of cardiac cath; e) detection of coronary anomalies in young persons (<30) with suggestive symptoms. considered experimental for persons with extensive calcification; atrial fib or other significant arrhythmia; inability to image at desired heart rate despite beta blockers; BMI>40, for asymptomatic persons or evaluation of persons at intermediate or high risk
Cigna
Covers 64 slice or greater as adjunct to other testing for the following indications: 1) detection of CAD in symptomatic (ie chest pain) patients if intermediate pre-angiography probability of CAD and ECG uninterpretable or patient unable to exercise; 2) for detection of CAD in symptomatic patients if patient exhibits intermediate pre-angiography probability of CAD and no ECG changes and serial enzymes negative. Also covered for suspected congenital anomalies of coronary circulation or great vessels, suspected peripheral arterial disease independent of # of slices.
Humana
Coverage is limited to devices with slice thickness of 1 mm or less and at least 40 slices per rotation for the following indications: CTA may be used as an alternative to stress echo or stress radionuclide scan in patients who have an equivocal or suspected inaccurate stress EKG (not covered for patients with typical angina and an abnormal stress EKG or stress imaging test). Covered for suspected congenital abnormalities of coronary circulation, to evaluation of chest pain in the ER, and for the assessment of coronary or pulmonary venous anatomy.
United Healthcare
Covered when using machines with 64-slices or greater for the assessment of patients with known or suspected CAD. This includes patients with chest pain syndrome and intermediate pre-angiography probability of CAD when ECG is uninterpretable or patient is unable to exercise; patients with chest pain syndrome and prior uninterpretable or equivocal stress test or patients with acute chest pain and intermediate pre-angiography probability of CAD, no ECG changes and negative serial enzymes. Also covered for assessment of patients with known and suspected coronary anomalies or congenital heart disease. Not covered when using fewer than 64 slice technology or for screening.
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Medicare: Noridian (equipment have collimation of .625 mm or less and a rotational speed of 375 msec or less OR AT LEAST 64 SLICES)
Commerical Payers:
Aetna
Equipment must have 64 slices; considered medically necessary for: a) rule out stenosis for persons with low or very low pre-test risk based on Framingham or ACC criteria with any of the following indications: 1) persons with chest pain who cannot have exercise or pharmacologic stress testing; 2) persons with positive stress test; 3) evaluating chest pain in ER when imaging stress test or angiography are being deferred; b) evaluation of asymptomatic persons at low risk who have equivocal exercise or pharm. stress test; c) pre-op for persons undergoing high risk non cardiac surgery where imaging stress or angiography is being deferred; d) pre-op for planning noncoronary cardiac surgery in lieu of cardiac cath; e) detection of coronary anomalies in young persons (<30) with suggestive symptoms. considered experimental for persons with extensive calcification; atrial fib or other significant arrhythmia; inability to image at desired heart rate despite beta blockers; BMI>40, for asymptomatic persons or evaluation of persons at intermediate or high risk
Cigna
Covers 64 slice or greater as adjunct to other testing for the following indications: 1) detection of CAD in symptomatic (ie chest pain) patients if intermediate pre-angiography probability of CAD and ECG uninterpretable or patient unable to exercise; 2) for detection of CAD in symptomatic patients if patient exhibits intermediate pre-angiography probability of CAD and no ECG changes and serial enzymes negative. Also covered for suspected congenital anomalies of coronary circulation or great vessels, suspected peripheral arterial disease independent of # of slices.
Humana
Coverage is limited to devices with slice thickness of 1 mm or less and at least 40 slices per rotation for the following indications: CTA may be used as an alternative to stress echo or stress radionuclide scan in patients who have an equivocal or suspected inaccurate stress EKG (not covered for patients with typical angina and an abnormal stress EKG or stress imaging test). Covered for suspected congenital abnormalities of coronary circulation, to evaluation of chest pain in the ER, and for the assessment of coronary or pulmonary venous anatomy.
United Healthcare
Covered when using machines with 64-slices or greater for the assessment of patients with known or suspected CAD. This includes patients with chest pain syndrome and intermediate pre-angiography probability of CAD when ECG is uninterpretable or patient is unable to exercise; patients with chest pain syndrome and prior uninterpretable or equivocal stress test or patients with acute chest pain and intermediate pre-angiography probability of CAD, no ECG changes and negative serial enzymes. Also covered for assessment of patients with known and suspected coronary anomalies or congenital heart disease. Not covered when using fewer than 64 slice technology or for screening.
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Medicare: Noridian (equipment have collimation of .625 mm or less and a rotational speed of 375 msec or less OR AT LEAST 64 SLICES)
Commerical Payers:
Aetna
Equipment must have 64 slices; considered medically necessary for: a) rule out stenosis for persons with low or very low pre-test risk based on Framingham or ACC criteria with any of the following indications: 1) persons with chest pain who cannot have exercise or pharmacologic stress testing; 2) persons with positive stress test; 3) evaluating chest pain in ER when imaging stress test or angiography are being deferred; b) evaluation of asymptomatic persons at low risk who have equivocal exercise or pharm. stress test; c) pre-op for persons undergoing high risk non cardiac surgery where imaging stress or angiography is being deferred; d) pre-op for planning noncoronary cardiac surgery in lieu of cardiac cath; e) detection of coronary anomalies in young persons (<30) with suggestive symptoms. considered experimental for persons with extensive calcification; atrial fib or other significant arrhythmia; inability to image at desired heart rate despite beta blockers; BMI>40, for asymptomatic persons or evaluation of persons at intermediate or high risk
Cigna
Covers 64 slice or greater as adjunct to other testing for the following indications: 1) detection of CAD in symptomatic (ie chest pain) patients if intermediate pre-angiography probability of CAD and ECG uninterpretable or patient unable to exercise; 2) for detection of CAD in symptomatic patients if patient exhibits intermediate pre-angiography probability of CAD and no ECG changes and serial enzymes negative. Also covered for suspected congenital anomalies of coronary circulation or great vessels, suspected peripheral arterial disease independent of # of slices.
Humana
Coverage is limited to devices with slice thickness of 1 mm or less and at least 40 slices per rotation for the following indications: CTA may be used as an alternative to stress echo or stress radionuclide scan in patients who have an equivocal or suspected inaccurate stress EKG (not covered for patients with typical angina and an abnormal stress EKG or stress imaging test). Covered for suspected congenital abnormalities of coronary circulation, to evaluation of chest pain in the ER, and for the assessment of coronary or pulmonary venous anatomy.
United Healthcare
Covered when using machines with 64-slices or greater for the assessment of patients with known or suspected CAD. This includes patients with chest pain syndrome and intermediate pre-angiography probability of CAD when ECG is uninterpretable or patient is unable to exercise; patients with chest pain syndrome and prior uninterpretable or equivocal stress test or patients with acute chest pain and intermediate pre-angiography probability of CAD, no ECG changes and negative serial enzymes. Also covered for assessment of patients with known and suspected coronary anomalies or congenital heart disease. Not covered when using fewer than 64 slice technology or for screening.
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Medicare: Noridian (equipment have collimation of .625 mm or less and a rotational speed of 375 msec or less OR AT LEAST 64 SLICES)
Commerical Payers:
Aetna
Equipment must have 64 slices; considered medically necessary for: a) rule out stenosis for persons with low or very low pre-test risk based on Framingham or ACC criteria with any of the following indications: 1) persons with chest pain who cannot have exercise or pharmacologic stress testing; 2) persons with positive stress test; 3) evaluating chest pain in ER when imaging stress test or angiography are being deferred; b) evaluation of asymptomatic persons at low risk who have equivocal exercise or pharm. stress test; c) pre-op for persons undergoing high risk non cardiac surgery where imaging stress or angiography is being deferred; d) pre-op for planning noncoronary cardiac surgery in lieu of cardiac cath; e) detection of coronary anomalies in young persons (<30) with suggestive symptoms. considered experimental for persons with extensive calcification; atrial fib or other significant arrhythmia; inability to image at desired heart rate despite beta blockers; BMI>40, for asymptomatic persons or evaluation of persons at intermediate or high risk.
Cigna
Covers 64 slice or greater as adjunct to other testing for the following indications: 1) detection of CAD in symptomatic (ie chest pain) patients if intermediate pre-angiography probability of CAD and ECG uninterpretable or patient unable to exercise; 2) for detection of CAD in symptomatic patients if patient exhibits intermediate pre-angiography probability of CAD and no ECG changes and serial enzymes negative. Also covered for suspected congenital anomalies of coronary circulation or great vessels, suspected peripheral arterial disease independent of # of slices.
Humana
Coverage is limited to devices with slice thickness of 1 mm or less and at least 40 slices per rotation for the following indications: CTA may be used as an alternative to stress echo or stress radionuclide scan in patients who have an equivocal or suspected inaccurate stress EKG (not covered for patients with typical angina and an abnormal stress EKG or stress imaging test). Covered for suspected congenital abnormalities of coronary circulation, to evaluation of chest pain in the ER, and for the assessment of coronary or pulmonary venous anatomy.
United Healthcare
Covered when using machines with 64-slices or greater for the assessment of patients with known or suspected CAD. This includes patients with chest pain syndrome and intermediate pre-angiography probability of CAD when ECG is uninterpretable or patient is unable to exercise; patients with chest pain syndrome and prior uninterpretable or equivocal stress test or patients with acute chest pain and intermediate pre-angiography probability of CAD, no ECG changes and negative serial enzymes. Also covered for assessment of patients with known and suspected coronary anomalies or congenital heart disease. Not covered when using fewer than 64 slice technology or for screening.
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Medicare: Noridian (equipment have collimation of .625 mm or less and a rotational speed of 375 msec or less OR AT LEAST 64 SLICES)
Commerical Payers:
Aetna
Equipment must have 64 slices; considered medically necessary for: a) rule out stenosis for persons with low or very low pre-test risk based on Framingham or ACC criteria with any of the following indications: 1) persons with chest pain who cannot have exercise or pharmacologic stress testing; 2) persons with positive stress test; 3) evaluating chest pain in ER when imaging stress test or angiography are being deferred; b) evaluation of asymptomatic persons at low risk who have equivocal exercise or pharm. stress test; c) pre-op for persons undergoing high risk non cardiac surgery where imaging stress or angiography is being deferred; d) pre-op for planning noncoronary cardiac surgery in lieu of cardiac cath; e) detection of coronary anomalies in young persons (<30) with suggestive symptoms. considered experimental for persons with extensive calcification; atrial fib or other significant arrhythmia; inability to image at desired heart rate despite beta blockers; BMI>40, for asymptomatic persons or evaluation of persons at intermediate or high risk
Cigna
Covers 64 slice or greater as adjunct to other testing for the following indications: 1) detection of CAD in symptomatic (ie chest pain) patients if intermediate pre-angiography probability of CAD and ECG uninterpretable or patient unable to exercise; 2) for detection of CAD in symptomatic patients if patient exhibits intermediate pre-angiography probability of CAD and no ECG changes and serial enzymes negative. Also covered for suspected congenital anomalies of coronary circulation or great vessels, suspected peripheral arterial disease independent of # of slices.
Humana
Coverage is limited to devices with slice thickness of 1 mm or less and at least 40 slices per rotation for the following indications: CTA may be used as an alternative to stress echo or stress radionuclide scan in patients who have an equivocal or suspected inaccurate stress EKG (not covered for patients with typical angina and an abnormal stress EKG or stress imaging test). Covered for suspected congenital abnormalities of coronary circulation, to evaluation of chest pain in the ER, and for the assessment of coronary or pulmonary venous anatomy.
United Healthcare
Covered when using machines with 64-slices or greater for the assessment of patients with known or suspected CAD. This includes patients with chest pain syndrome and intermediate pre-angiography probability of CAD when ECG is uninterpretable or patient is unable to exercise; patients with chest pain syndrome and prior uninterpretable or equivocal stress test or patients with acute chest pain and intermediate pre-angiography probability of CAD, no ECG changes and negative serial enzymes. Also covered for assessment of patients with known and suspected coronary anomalies or congenital heart disease. Not covered when using fewer than 64 slice technology or for screening.
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Medicare: Noridian (equipment have collimation of .625 mm or less and a rotational speed of 375 msec or less OR AT LEAST 64 SLICES)
Commerical Payers:
Aetna
Equipment must have 64 slices; considered medically necessary for: a) rule out stenosis for persons with low or very low pre-test risk based on Framingham or ACC criteria with any of the following indications: 1) persons with chest pain who cannot have exercise or pharmacologic stress testing; 2) persons with positive stress test; 3) evaluating chest pain in ER when imaging stress test or angiography are being deferred; b) evaluation of asymptomatic persons at low risk who have equivocal exercise or pharm. stress test; c) pre-op for persons undergoing high risk non cardiac surgery where imaging stress or angiography is being deferred; d) pre-op for planning noncoronary cardiac surgery in lieu of cardiac cath; e) detection of coronary anomalies in young persons (<30) with suggestive symptoms. considered experimental for persons with extensive calcification; atrial fib or other significant arrhythmia; inability to image at desired heart rate despite beta blockers; BMI>40, for asymptomatic persons or evaluation of persons at intermediate or high risk.
Cigna
Covers 64 slice or greater as adjunct to other testing for the following indications: 1) detection of CAD in symptomatic (ie chest pain) patients if intermediate pre-angiography probability of CAD and ECG uninterpretable or patient unable to exercise; 2) for detection of CAD in symptomatic patients if patient exhibits intermediate pre-angiography probability of CAD and no ECG changes and serial enzymes negative. Also covered for suspected congenital anomalies of coronary circulation or great vessels, suspected peripheral arterial disease independent of # of slices.
Humana
Coverage is limited to devices with slice thickness of 1 mm or less and at least 40 slices per rotation for the following indications: CTA may be used as an alternative to stress echo or stress radionuclide scan in patients who have an equivocal or suspected inaccurate stress EKG (not covered for patients with typical angina and an abnormal stress EKG or stress imaging test). Covered for suspected congenital abnormalities of coronary circulation, to evaluation of chest pain in the ER, and for the assessment of coronary or pulmonary venous anatomy.
United Healthcare
Covered when using machines with 64-slices or greater for the assessment of patients with known or suspected CAD. This includes patients with chest pain syndrome and intermediate pre-angiography probability of CAD when ECG is uninterpretable or patient is unable to exercise; patients with chest pain syndrome and prior uninterpretable or equivocal stress test or patients with acute chest pain and intermediate pre-angiography probability of CAD, no ECG changes and negative serial enzymes. Also covered for assessment of patients with known and suspected coronary anomalies or congenital heart disease. Not covered when using fewer than 64 slice technology or for screening.
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