BlueCross BlueShield of Tennessee Medical Policy Manual

Computed Tomography to Detect Coronary Artery Calcification (i.e., calcium scoring)


Several types of fast computed tomography (CT) imaging, including electron beam (EBCT), helical, multislice spiral, or multidetector row, allow the quantification of calcium (i.e., calcium scoring) in coronary arteries. Coronary artery calcium is present in coronary atherosclerosis, but the atherosclerosis detected may or may not cause ischemia or symptoms. The most widely studied indication for the use of calcium scoring is the prediction of future risk for coronary artery disease in individuals with subclinical disease. In addition, calcium scoring has been evaluated in individuals with symptoms potentially consistent with coronary artery disease, but in whom a diagnosis is unclear.





Typical angina is described as substernal chest pain or discomfort (e.g., pressure, heaviness, burning or tightness) generally brought on by exertion or emotional stress that may radiate to the left arm or jaw.


American College of Cardiology Foundation, American Heart Association, et al. (2012). 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: Executive summary. Retrieved August 13, 2021 from

American College of Cardiology Foundation, American Heart Association, et al. (2014). ACCF/AHA/ASE/ASNC/HFSA/HRS/SCAI/SCCT/SCMR/STS 2013 multimodality appropriate use criteria for the detection and risk assessment of stable ischemic heart disease. Retrieved May 28, 2019 from

American College of Cardiology Foundation, et al. (2010). ACCF/SCCT/ACR/AHA/ASE/ASNC/NASCI/SCAI/SCMR 2010 appropriate use criteria for cardiac computed tomography: a report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, the Society of Cardiovascular Computed Tomography, the American College of Echocardiography, the American Society of Nuclear Cardiology, the North American Society for Cardiovascular Imaging, the Society for Cardiovascular Angiography and Interventions, and the Society for Cardiovascular Magnetic Resonance. Retrieved August 13, 2021 from

American College of Cardiology, American Heart Association. (2019). 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease. Retrieved May 28, 2019 from

American College of Radiology, American College of Cardiology, et al. (2015).  2015 ACR/ACC/AHA/AATS/ACEP/ASNC/NASCI/SAEM/SCCT/SCMR/SCPC/SNMMI/STR/STS appropriate utilization of cardiovascular imaging in emergency department patients with chest pain. Retrieved August 13, 2021 from

eviCore Healthcare. (2021, February). Clinical guidelines: cardiac imaging policy, version 1.0. Retrieved August 13, 2021 from




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