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 post-processing of a medically indicated CCTA that meets all CCT/CCTA requirements and only after the base CCTA is completed and interpreted; clinical documentation must demonstrate the pre-test probability for coronary artery disease and symptoms consistent with stable ischemic heart disease. Claims must include a valid ICD-10-CM diagnosis code and the referring/ordering physician's name and NPI; billing may be subject to NCCI/OPPS edits and modifier/ABN rules (GA/GX/GY/GZ) which can trigger automatic denials or additional claim requirements.

"Patient must have a medically indicated coronary CT angiography (CCTA) and meet all requirements for Cardiac Computed Tomography (CCT) and CCTA for AI-QCT/AI-CPA to be covered."

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