S8092, Electron beam computed tomography (also known as ultrafast ct, cine ct)
HCPCS/CPT
Prior Authorization
Prior Auth Required
Code explicitly requires prior authorization (high confidence)
Medicare Pricing
Work RVU
0.00
Facility
N/A
Non-Facility
N/A
Documentation Required
- No specific documentation requirements are stated in this Clinical Policy Bulletin.
Key Coverage Criteria
- None — Aetna considers total body (full-body or whole-body) CT screening or full-body ultrafast (electron-beam) CT screening experimental and investigational because it has not been shown to be effective as a screening test.
- Total-body CT screening for patients with no symptoms or a family history suggesting disease is not supported (per ACR statement quoted in the policy).
- BCBSIL does not cover CT detection of coronary artery calcification (CAC) for asymptomatic or symptomatic scenarios unless specific state-mandated exceptions apply; generally not medically necessary.
- CAC CT for detection of coronary artery calcification is not medically necessary.
- Indication: Coronary artery calcium (CAC) testing is medically necessary to assist with management of hyperlipidemia when age 40-75, LDL cholesterol 70-190 mg/dL, no known ASCVD, non-diabetic, and 10-year ASCVD risk 5-20%.
- Cardiac CT is medically necessary to evaluate suspected or established congenital heart disease when echocardiography is technically limited or non-diagnostic.
15 Active Policies
AETNA-CPB-0603, Total-Body CT Screening
BCBSIL-RAD604.009, Computed Tomography to Detect Coronary Artery Calcification
BCBSMT-RAD604.009, Computed Tomography to Detect Coronary Artery Calcification
BCBSNM-RAD604.009, Computed Tomography to Detect Coronary Artery Calcification
BCBSOK-RAD604.009, Computed Tomography to Detect Coronary Artery Calcification
Related Codes
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