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 after a medically indicated CCTA that meets LCD L35121 requirements and only after the CCTA has been completed and interpreted. Claims must include a valid ICD‑10‑CM diagnosis code, the referring/ordering physician name and NPI, and medical record documentation supporting pre-test probability of CAD, symptoms, clinical indication, the CCTA report, and the AI analysis report; billing must also comply with NCCI/OPPS and applicable ABN/modifier rules.

"AI-QCT/AI-CPA is covered only for patients who have a medically indicated coronary CT angiography (CCTA) and who meet all requirements specified in LCD L35121."

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