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.
Computed tomography (CT) to detect coronary artery calcification is considered medically necessary when criteria are met. (See Medical Appropriateness below.)
Computed tomography (CT) to detect coronary artery calcification in asymptomatic individuals with any degree of risk for coronary artery disease is considered investigational.
Computed tomography (CT) to detect coronary artery calcification is considered medically appropriate if ALL of the following are met:
Individual is diagnosed with ANY ONE of the following:
Atypical angina (i.e., chest pain or discomfort [arm or jaw pain] that lacks one of the characteristics of definite or typical angina)
Non-anginal chest pain (chest pain or discomfort that meets one or none of the typical angina characteristics)
Individual is classified as ANY ONE of the following:
Very low risk (i.e., less than 5% pre-test probability)
Low risk (i.e., between 5 and 10% pre-test probability)
Any specific products referenced in this policy are just examples and are intended for illustrative purposes only. It is not intended to be a recommendation of one product over another, and is not intended to represent a complete listing of all products available. These examples are contained in the parenthetical e.g. statement.
We develop Medical Policies to provide guidance to Members and Providers. This Medical Policy relates only to the services or supplies described in it. The existence of a Medical Policy is not an authorization, certification, explanation of benefits or a contract for the service (or supply) that is referenced in the Medical Policy. For a determination of the benefits that a Member is entitled to receive under his or her health plan, the Member's health plan must be reviewed. If there is a conflict between the Medical Policy and a health plan, the express terms of the health plan will govern.
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 https://www.acc.org/guidelines/.
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 https://www.acc.org/guidelines/.
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 https://www.acc.org/guidelines/.
American College of Cardiology, American Heart Association. (2019). 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease. Retrieved May 28, 2019 from https://www.acc.org/guidelines/.
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 https://www.acc.org/guidelines/.
eviCore Healthcare. (2021, February). Clinical guidelines: cardiac imaging policy, version 1.0. Retrieved August 13, 2021 from https://www.evicore.com.
MOST RECENT REVIEW DATE: 10/14/2021