Cardiac CT, Coronary CT Angiography, Calcium Scoring and CT Fractional Flow Reserve

Aetna covers cardiac CT angiography using ≥64‑slice scanners to exclude obstructive coronary stenosis in symptomatic patients with low‑to‑intermediate pretest probability (Framingham/Pooled Cohort/ACC), after a positive stress test, for asymptomatic intermediate‑risk patients with equivocal/uninterpretable stress tests or specified ECG changes, and as pre‑op assessment for high‑risk noncardiac or planned non‑coronary cardiac surgery under the stated criteria. CTA is considered not medically necessary/experimental for <64‑slice scanners, screening asymptomatic or high‑pretest‑probability patients, serial calcium scoring (except specific repeat criteria), and in patients with BMI>40, inability to image at target heart rate (<80 bpm) despite beta‑blockade, uncontrolled arrhythmia/atrial fibrillation, extensive coronary calcification or Agatston >1000 (with limited exceptions for 3rd‑gen DSCT 120‑kV and rate‑controlled AF).

"Cardiac CT angiography (64-slice or greater) medically necessary for evaluation of in-stent stenosis."