Billing and Coding: Artificial Intelligence Enabled CT Based Quantitative Coronary Topography (AI-QCT)/Coronary Plaque Analysis (AI-CPA)

AI‑QCT/AI‑CPA is covered only as a post‑processing analysis of a medically indicated CCTA that meets the CCTA LCD (L33423) and related AI‑QCT LCD (L39851); the base CCTA must be completed and interpreted before AI‑QCT/AI‑CPA is performed. Claims must include appropriate documentation (history/physical to assess pre‑test CAD probability, symptoms consistent with stable ischemic heart disease when applicable, clinical findings prompting CCTA, CCTA and AI‑QCT reports) and the referring/ordering physician name and NPI; valid ICD‑10 codes are required. Billing must conform to NCCI/OPPS edits and ABN/modifier rules (-GA, -GX, -GZ, -GY) as described, with Part A-specific requirements (occurrence code 32 and ABN date) when applicable.

"Patient must have a medically indicated coronary CT angiography (CCTA) that meets all requirements of the related LCD (see CCTA LCD L33423)."