Non-Invasive Fractional Flow Reserve (FFR) for Ischemic Heart Disease

FDA‑approved noninvasive FFRct is covered for selected intermediate‑risk patients with acute or stable chest pain when CCTA demonstrates 40–90% proximal or mid coronary stenosis, and for stable non‑obstructive CAD with persistent ischemic symptoms despite maximally tolerated medical therapy, used as an alternative to stress testing. FFRct is contraindicated or not reasonable with prior intracoronary stents, CABG grafts, prosthetic valves, recent MI (≤30 days), heart transplant, pacemaker/ICD leads, newly diagnosed systolic heart failure without prior left heart catheterization, suspected acute coronary syndrome not yet ruled out, and when CCTA shows >90% or <40% stenosis or when turnaround time would delay care. Documentation must include a completed/interpreted CCTA with images and percent stenosis, guideline‑based risk classification, evidence of maximally tolerated medical therapy when applicable, and confirmation of FDA‑approved FFRct software and image quality.