Computed Tomography to Detect Coronary Artery Calcification

This policy covers computed tomography (EBCT, multidetector/spiral CT or CT angiography) to detect and quantify coronary artery calcification (CAC) for risk assessment and to guide preventive or diagnostic management. Coverage is limited to specific age and risk groups (for example, Texas exceptions for males >45 and <76 with diabetes and females >55 and <76 with intermediate-or-higher Framingham risk, and some contracts for ages 45–65 with intermediate 10‑year risk), is generally limited to one scan every five years, and is subject to the member’s benefit plan/contract, state-law exceptions, and other exclusions (including instances where CAC testing is not medically necessary or not separately payable).

"Cardiac CT measuring coronary artery calcification (including screening for atherosclerosis and abnormal artery structure/function) allowed once every five years for Texas enrollees who are male >4..."