Billing and Coding: Cardiac Computed Tomography (CCT) and Coronary Computed Tomography Angiography (CCTA)

Coverage for CCT/CCTA requires documentation supporting medical necessity per Local Coverage Determination L33947 and submission of appropriate ICD-10-CM diagnosis codes; ordering provider identity (name and NPI) and a formal interpretive report with images and reconstruction data must be maintained. Advance Beneficiary Notice (CMS‑R‑131) and appropriate G‑modifiers (GA, GX, GZ, GY) guidance applies for anticipated denials, with certain modifiers triggering automatic denials by Part A MACs and occurrence code/form requirements for ABNs; limitation of liability rules and bill-type instructions also apply as specified.

"CCT/CCTA is covered when the patient's medical record documents medical necessity consistent with Local Coverage Determination L33947 and the claim is submitted with an appropriate ICD-10-CM diagno..."

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