Artificial Intelligence Enabled CT Based Quantitative Coronary Topography (AI-QCT )/Coronary Plaque Analysis (AI-CPA)

AI‑QCT/AI‑CPA on CCTA is covered as medically necessary for diagnostic evaluation of patients with acute or stable chest pain and no known CAD who are eligible for CCTA and whose base CCTA shows intermediate risk or CAD‑RADS 1–3; it is not covered for disease surveillance, asymptomatic prognostic use, within 30 days post‑MI, with unstable coronary symptoms, normal CCTA (CAD‑RADS 0), high‑grade stenosis/CAD‑RADS 4–5, or known obstructive CAD. Coverage requires completion and interpretation of the base CCTA first, use of FDA‑cleared/approved software, performance/interpretation by appropriately credentialed physicians, documentation of CCTA findings and timing (e.g., >30 days post‑MI), and compliance with CMS medical‑necessity and billing/coding requirements.

"AI-QCT/AI-CPA should not be performed until after the base study (CCTA) has been completed and interpreted."