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Electron-beam CT (also known as ultrafast CT) uses an electron gun rather than a standard x-ray tube to generate x-rays, thus permitting very rapid scanning. Spiral CT scanning (also referred to as helical CT scanning) also creates images at greater speeds by rotating a standard x-ray tube around the patient such that data are gathered in a continuous spiral or helix rather than individual slices.
While both electron-beam CT (EBCT) and spiral CT scanning may be valued as an alternative to conventional CT scanning due to their faster throughput, their speed of image acquisition permits unique imaging of the moving heart. For example, the rapid image acquisition time virtually eliminates motion artifact related to cardiac contraction, permitting visualization of the calcium in the epicardial coronary arteries. EBCT software permits quantification of calcium area and density, which are translated into calcium scores. Calcium scores have been investigated as a technique for detecting coronary artery calcification, both as a diagnostic technique in symptomatic patients to rule out an atherosclerotic etiology of symptoms or, in asymptomatic patients, as an adjunctive method for risk stratification for coronary artery disease.
EBCT and multi-detector computed tomography (MDCT) were initially the primary fast CT methods for measurement of coronary artery calcification. A fast CT study for coronary artery calcuim measurement generally takes 10 to 15 minutes and requires only a few seconds of scanning time. More recently, CT angiography has been used to assess coronary calcium. Because of the basic similarity between EBCT and CT angiography in measuring coronary calcium, it is expected that CT angiography provides similar information on coronary calcium as does EBCT.
POLICYThe use of computed tomography (CT) to detect coronary artery calcification is considered investigational.
POLICY EXCEPTIONSEffective retroactively to November 17, 1999, and forward, for the Federal Employee Program (FEP) only, Other Medical Benefits may be considered for this procedure based on medical necessity. This procedure is to be considered only for diagnostic services under Other Medical Benefits and is not to be considered as a routine/preventive screening service under Additional Benefits. Under the Blue Cross & Blue Shield Service Benefit Plan, routine services (i.e., services not related to a specific illness, injury, set of symptoms or maternity care) are excluded except for those preventive/routine services specifically described in the Service Benefit Plan brochure.
Effective retroactively to November 17, 1999, and forward, for the Federal Employee Program (FEP) only, plans are to implement this policy immediately. Since there is no specific CPT code for EBCT scanning of the heart, providers may possibly code this service by using 71250, CT scan of the thorax. Claims for EBCT scanning of the heart may be identified by CPT 71250 in conjunction with an ICD-9 Diagnosis Code describing coronary artery disease. (Document #00-081HR)
POLICY GUIDELINESInvestigative service is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized by certifying boards and/or approving or licensing agencies or published peer review criteria as standard, effective medical practice for the treatment of the condition being treated and as such therefore is not considered medically necessary.
The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language.
POLICY HISTORY2/1998: Approved by Medical Policy Advisory Committee (MPAC)
5/1999: Reviewed by MPAC; investigational status maintained
11/1999: Reviewed by MPAC; investigational status maintained for all indications
2/2000: Revisions for FEP only
2/8/2002: Investigational definition added
4/26/2002: Type of Service and Place of Service deleted
5/17/2002: Code Reference section completed
6/13/2002: Code Reference section updated
8/7/2002: Sources section updated
2/12/2004: Code Reference section updated, CPT code 76499 deleted
3/25/2004: Reviewed by MPAC, remains investigational, Policy title "Electron Beam Computed Tomography" renamed "Computed Tomography to Detect Coronary Artery Calcification", Description and Policy sections revised to be consistent with BCBSA policy # 6.01.03, Sources updated
5/19/2004: Code Reference section reviewed, no changes
3/13/2006: Coding updated. CPT4 2006 revisions added to policy
3/16/2006: Policy reviewed, no changes
6/29/2006: Code reference section updated, CPT codes 76376 and 76377 deleted. CPT codes 0146T, 0147T, 0148T, 0149T added to non-covered table.
1/30/2007: Code reference section reviewed and updated. CPT codes 0146T and 0148T deleted. CPT code 0144T added
5/15/2007: Policy reviewed, no changes
10/9/2007: Code reference section reviewed; CPT codes 0147T and 0149T removed
7/10/2009: Policy reviewed, no changes
4/20/2010: Coding Section revised for 2010 CPT4 and HCPCS revisions
08/03/2011: Policy reviewed. Policy statement unchanged. Deleted outdated references from the Sources section.
09/25/2012: Policy reviewed; no changes.
10/15/2013: Policy reviewed; no changes.
06/18/2014: Policy reviewed; description updated regarding CT angiography. Policy statement revised to change "electron-beam CT or spiral" to "computed tomography" to reflect the scope of the policy; intent unchanged. Removed deleted CPT code 0144T from the Code Reference section.
SOURCE(S)Blue Cross Blue Shield Association policy #6.01.03
CODE REFERENCEThis may not be a comprehensive list of procedure codes applicable to this policy.