Coronary CT Angiography, Fractional Flow Reserve with CT and Adjunctive Testing - Medicare Advantage

This Humana Medicare Advantage medical coverage policy defers to applicable CMS NCDs and LCDs for coverage of CCTA, FFR_CT, AI-based plaque analysis and coronary artery calcium scoring; where no LCD exists in a jurisdiction, the policy specifies which LCD criteria Humana will apply. CCTA is described as a noninvasive alternative to invasive angiography for diagnosing CAD and for evaluation of chest pain, congenital coronary anomalies, thoracic aortic disease, and valvular disease; FFR_CT is indicated to noninvasively evaluate coronary blood flow in known or suspected CAD. The policy explicitly excludes certain adjunctive technologies (3D predictive modeling C9793, AI-CSQ, cardiac acoustic waveform 0716T, CorVista, noncoronary plaque analysis 0710T–0713T, and quantitative CT tissue characterization 0721T/0722T) as not medically reasonable and necessary.

"Coronary computed tomography angiography (CCTA) as a noninvasive alternative to invasive cardiac angiography (cardiac catheterization) for diagnosing coronary artery disease (CAD) by visualizing bl..."