C7558, Catheter placement in coronary artery(s) for coronary angiography, including
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- Documentation must accurately reflect the clinical situation at the time of the requested service.
Key Coverage Criteria
- Diagnostic coronary angiography is considered medically necessary in ANY of the following scenarios:
- Significant stenosis (≥ 50%) in an unprotected left main coronary artery on recent CCTA.
- Lesions of unclear severity in an unprotected left main coronary artery on recent CCTA.
- Persistence or recurrence of unacceptable symptoms despite GDMT in patients with established CAD.
- Stress-induced left ventricular dilation.
- Newly recognized resting LV systolic dysfunction (ejection fraction ≤ 40%).
2 Active Policies
CARELON-diagnostic-coronary-angiography-2023-04-01-updated-2024-11-17-for-anthem-bcbs-ohio-medicaid, Diagnostic Coronary Angiography
CARELON-diagnostic-coronary-angiography-2025-11-15, Diagnostic Coronary Angiography
Related Codes
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