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-procedure analysis when the patient has a medically indicated CCTA and all requirements of LCD L33559 are met; the CCTA must be completed and interpreted before the AI analysis. Claims must include a valid ICD-10-CM diagnosis, the ordering/referring physician name and NPI, supporting clinical documentation (history, exam, symptoms, CCTA report, AI analysis report), and follow ABN/modifier guidance when services are expected to be non-covered.

"Patient must have a medically indicated coronary CT angiography (CCTA) and meet all requirements per LCD L33559 prior to AI-QCT/AI-CPA analysis."

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