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

FFRct (FDA‑approved noninvasive CT-derived FFR) is reasonable for intermediate-risk patients with acute or stable chest pain when CCTA demonstrates 40–90% stenosis in a proximal or mid coronary artery, and for select patients with persistent ischemic symptoms despite maximal medical therapy. FFRct is only performed after a completed/interpreted CCTA and is not reasonable for patients with prior intracoronary stents, CABG grafts, prosthetic valves, recent MI (≤30 days), certain device leads, suspected acute coronary syndrome, very low (<40%) or very high (>90%) stenoses, or when post-processing turnaround would delay care. Some indications in the policy text are ambiguous and flagged for manual review (e.g., specific language about left main intermediate stenosis and several truncated sentences).

"FFRct is reasonable for intermediate-risk patients (per 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR chest pain guideline) with acute or stable chest pain, no prior known coronary artery stenosis, and CCT..."