LCD for Cardiac Computed Tomography (CCT) and Coronary Computed Tomography Angiography (CCTA) (L25907)


Contractor Information

 
Contractor Name 
National Government Services, Inc.
Contractor Number 
NumberTypeState(s)
00130 FI IN
00131 FI IL
00160 FI KY
00332 FI OH
00450 FI WI
00452 FI MI
00453 FI VA, WV
00630 Carrier IN
00660 Carrier KY
13101 MAC CT – Part A
13102 MAC CT – Part B
13201 MAC NY – Part A
13202 MAC NY – Part B
13282 MAC NY – Part B
13292 MAC NY – Part B
Contractor Type 
Carrier
Fiscal Intermediary
MAC – Part A
MAC- Part B


LCD Information

 
LCD ID Number 
L25907 
 
LCD Title 
Cardiac Computed Tomography (CCT) and Coronary Computed Tomography Angiography (CCTA) 
 
Contractor's Determination Number 
L25907(R6) 
 
AMA CPT / ADA CDT Copyright Statement 
CPT codes, descriptions and other data only are copyright 2010 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS Clauses Apply. Current Dental Terminology, (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. © 2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply.  
 
CMS National Coverage Policy 
Language quoted from Center for Medicare and Medicaid Services (CMS), National Coverage Determinations (NCDs) and coverage provisions in interpretive manuals is italicized throughout the policy. NCDs and coverage provisions in interpretive manuals are not subject to the Local Coverage Determination (LCD) Review Process (42 CFR 405.860[b] and 42 CFR 426 [Subpart D]). In addition, an administrative law judge may not review an NCD. See Section 1869(f)(1)(A)(i) of the Social Security Act.

Unless otherwise specified, italicized text represents quotation from one or more of the following CMS sources:

Title XVIII of the Social Security Act (SSA):

Section 1862(a)(1)(A) excludes expenses incurred for items or services which are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.

Section 1833(e) prohibits Medicare payment for any claim which lacks the necessary information to process the claim.

Section 1862 (a)(7) excludes routine physical examinations.

Code of Federal Regulations:

42 CFR Section 410.32 indicates that diagnostic tests may only be ordered by the treating physician (or other treating practitioner acting within the scope of his or her license and Medicare requirements) who furnishes a consultation or treats a beneficiary for a specific medical problem and who uses the results in the management of the beneficiary's specific medical problem. Tests not ordered by the physician (or other qualified non-physician provider) who is treating the beneficiary are not reasonable and necessary (see Sec. 411.15(k)(1) of this chapter).

CMS Publications:

CMS Publication 100-3, National Coverage Determination Manual, Chapter 1
220.1 Computerized Tomography

CMS Publication 100-4, Medicare Claims Processing Manual, Chapter 13
20 Payment Conditions for Radiology Services

CMS Publication 100-9, Contractor Beneficiary and Provider Communication Manual, Chapter 5
20 Correct Coding Initiative
 
 
Primary Geographic Jurisdiction
NumberTypeState(s)
00130 FI IN
00131 FI IL
00160 FI KY
00332 FI OH
00450 FI WI
00452 FI MI
00453 FI VA, WV
00630 Carrier IN
00660 Carrier KY
13101 MAC CT – Part A
13102 MAC CT – Part B
13201 MAC NY – Part A
13202 MAC NY – Part B
13282 MAC NY – Part B
13292 MAC NY – Part B
 
Oversight Region
Region I, II, III, V
 
 
Original Determination Effective Date 
For services performed on or after 12/01/2007  
 
Original Determination Ending Date 
 
 
Revision Effective Date 
For services performed on or after 01/01/2011  
 
Revision Ending Date 
 
 
Indications and Limitations of Coverage and/or Medical Necessity 
Abstract:

The multidetector helical computed tomography (MDCT) technology requires thin (up to 1 mm) slices, 0.5 to 0.75 mm reconstructions, multiple simultaneous images (e.g. 16, 32, 64 or more slices), and cardiac gating (often requiring beta blockers for ideal heart rate). There is significant post-processing, depending on the number of slices per second for image generation. For coronary artery imaging, the resulting images show a high correlation with stenotic lesions noted on diagnostic cardiac catheterization but more importantly, with atheromas on intracoronary ultrasound.

Current available body of evidence demonstrates that CCTA can reliably rule out the presence of significant coronary artery disease (CAD) in patients with a low to intermediate probability of having CAD and can reliably achieve a high degree of diagnostic accuracy and technical performance necessary to replace conventional angiography.

Indications:

  1. Patient presenting with chest pain syndrome.

    CCTA may be used in lieu of an imaging stress test. The clinician must have a high degree of suspicion that CAD is high on the differential diagnosis of the symptoms.

  2. To facilitate the management decision of a patient with an equivocal stress test.

    CCTA might be chosen in select patients who have an equivocal stress (or stress imaging) test. The rationale is that a noninvasive coronary anatomic test (CCTA) allows an alternate method of assessing the coronary arteries, which would limit the number of negative invasive coronary angiograms.

  3. When the recurrence of symptoms in patients with known coronary artery disease may be related to progression/exacerbation of underlying disease.

    The use of CCTA in this setting would be to evaluate the extent of previously diagnosed coronary artery disease. Patients with known disease may have had remote invasive angiography and/or stress testing to evaluate prior events or symptoms. New or recurrent symptoms may relate to a change in the coronary anatomy that can be assessed with CCTA.

  4. When patients with prior bypass surgery or intracoronary artery stent placement present with chest pain or dyspnea.

    Coronary bypass grafts are relatively well seen with CCTA. The rationale for CCTA would be to determine the patency and severity of possible graft stenoses that may be the source of chest pain. Patients with prior intracoronary stents often present with recurrent chest pain. The rationale for a CCTA as an alternative to invasive angiography is to rule out in-stent restenosis as the cause of symptoms. (Accurate assessment of in-stent restenosis may be limited by the artifact caused by the stent material itself and the quality of the scan and scanner).

  5. Suspected congenital anomalies of the coronary circulation.

    CCTA is used to assess patients suspected of having a congenital coronary anomaly. The cross-sectional nature of this technique allows one to determine accurately both the presence and possible future harm that could result from the anomaly. It is often used after an anomaly has been identified following a different test such as prior invasive coronary angiogram. A CCTA is used to decide if surgery is indicated and for surgical planning.

  6. The assessment of coronary or pulmonary venous anatomy.

    This application of CTA for the coronary and pulmonary veins is primarily for pre-surgical planning. Coronary venous anatomy can be useful for the cardiologist who needs to place a pacemaker lead in the lateral coronary vein in order to resynchronize cardiac contraction in patients with heart failure. This may be helpful to guide biventricular pacemaker placement.

    Pulmonary vein anatomy can vary from patient to patient. Pulmonary vein catheter ablation can isolate electrical activity from the pulmonary veins and allow for the elimination of recurrent atrial fibrillation. The presence of a pulmonary venous anatomic map may help eliminate procedural complications and allow for the successful completion of the procedure.

  7. The patient undergoing non-coronary artery cardiac surgery.

    Certain patients who have non-coronary artery cardiac surgery (valve or ascending aortic surgery) may need a pre-operative invasive coronary angiogram. The surgical planning may also depend upon the exact location of the coronary arteries. The rationale for the use of CCTA in these patient subsets is to avoid potentially unnecessary invasive testing and still provide appropriate pre-surgical information.

  8. The test may be medically necessary in patients presenting to the emergency room with complaints consistent with cardiac ischemia, but without diagnostic electrocardiography (ECG) or enzymes.

  9. The test may be considered medically necessary in patients status post revascularization procedures who present with recurrent symptoms not clearly identifiable as ischemic.
Limitations:

  1. The test is never covered for screening, i.e., in the absence of signs, symptoms or disease.
  2. The test will be considered not medically necessary if the anticipated results are not expected to provide new, additional information to that already previously obtained from other tests (such as stress myocardial perfusion images or cardiac ultrasound). New or additional information should facilitate the management decision, not merely add a new layer of testing.
  3. For dates of service prior to 01/01/2010, determination of cardiac ejection fraction (CPT code 0151T) should not be billed when previously determined by other techniques. CPT code 0151T is deleted effective 12/31/2009.
  4. The test will be considered not medically necessary if it is anticipated that the patient would require invasive cardiac angiography for further diagnosis or for therapeutic intervention. (e.g., angina decubitus, unstable angina, Prinzmetal angina, etc.)
  5. The test may be denied, on post-pay review, as not medically necessary when used for cardiac evaluation if there were pre-test knowledge of sufficiently extensive calcification of the suspect coronary segment that would diminish the interpretive value.
  6. Effective 12/01/2009, coverage for evaluation of coronary artery or bypass graft stenosis, or for functional status (e.g., wall motion), is limited to multidetector scanners having at least 64 slices per rotation capability. This two year period (12/01/2007 - 12/01/2009 will allow for a phase-in of new technology.
  7. The administration of beta blockers and the monitoring of the patient during MDCT/CCTA by a physician experienced in the use of cardiovascular drugs is included as part of the test and is not a separately payable service.
  8. All studies must be ordered by the physician/qualified non-physician practitioner treating the patient and who will use the results of the test in the management of the patient.
  9. The test must be performed under the direct supervision of a physician.
  10. This LCD does not address electron beam tomography (EBT) technology or Ultrafast CT for coronary artery examination. There is no extension of coverage of EBT based on this policy.
  11. Quantitative calcium scoring (CPT code 0144T for dates of service prior to 01/01/2010, and CPT 75571 on or after 01/01/2010) is not a covered service and will be denied as not medically necessary. Calcium scoring reported in isolation is considered a screening service. When performed in association with CT angiography, there is neither separate nor additional included reimbursement for the calcium scoring.
  12. Acceptable Levels of Competence for Performance and Interpretation: Providers submitting claims for these tests must demonstrate proficiency and training in performing the tests according to the following standards:
      The acceptable levels of competence, as defined by the American College of Cardiology (ACC)/American Heart Association (AHA) Clinical Competence Statement on Cardiac Imaging with Computed Tomography and Magnetic Resonance (2005) and the American College of Radiology (ACR) Clinical Statement on Noninvasive Cardiac Imaging (2005), are outlined as follows:

      For the technical portion, a recommended level of competence is fulfilled when the image acquisition is obtained under all of the following conditions:
      1. The service is performed by a radiology technologist who is credentialed by a nationally recognized credentialing body (American Registry of Radiologic Technologists or equivalent) and meets state licensure requirements where applicable.
      2. If intravenous beta blockers or nitrates are to be given prior to a CT coronary angiogram, the test must be under the direct supervision of a certified registered nurse and physician (familiar with the administration of cardiac medications) who are available to respond to medical emergencies and it is strongly recommended that the certified register nurse and physician be ACLS certified.
      3. When contrast studies are performed, the physician must provide direct supervision and the radiologic technologist or registered nurse administering the contrast must have appropriate training on the use and administration of contrast media.

      For the professional portion, a recommended level of competence is fulfilled when the interpretation is performed by a physician meeting the following requirements:
      1. The physician has appropriate additional training in coronary CTA and cardiac CT imaging equivalent to the guidelines set forth by the ACC or ACR (for example: the ACCF/AHA Clinical Competence Statement on Cardiac Imaging with Computed Tomography and Magnetic Resonance (2005) and the ACR Clinical Statement on Noninvasive Cardiac Imaging (2005)), or
      2. The physician has appropriate medical staff privileges to interpret CT coronary angiograms at a hospital that participates in the Medicare program, and is actively training in cardiac CT (as in paragraph a). A grace period of 24 months will be allowed to acquire the necessary training.
Other Comments:

For claims submitted to the fiscal intermediary or Part A MAC: this coverage determination also applies within states outside the primary geographic jurisdiction with facilities that have nominated National Government Services to process their claims.

Bill type codes only apply to providers who bill these services to the fiscal intermediary or Part A MAC. Bill type codes do not apply to physicians, other professionals and suppliers who bill these services to the carrier or Part B MAC.

Limitation of liability and refund requirements apply when denials are likely, whether based on medical necessity or other coverage reasons. The provider/supplier must notify the beneficiary in writing, prior to rendering the service, if the provider/supplier is aware that the test, item or procedure may not be covered by Medicare. The limitation of liability and refund requirements do not apply when the test, item or procedure is statutorily excluded, has no Medicare benefit category or is rendered for screening purposes.

For dates of service prior to April 1, 2010, FQHC services should be reported with bill type 73X. For dates of service on or after April 1, 2010, bill type 77X should be used to report FQHC services. 
 


Coding Information

 
Bill Type Codes: 

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the policy does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims.

011x Hospital Inpatient (Including Medicare Part A)
012x Hospital Inpatient (Medicare Part B only)
013x Hospital Outpatient
073x Clinic - Freestanding
077x Clinic - Federally Qualified Health Center (FQHC)
085x Critical Access Hospital
 
 
Revenue Codes: 

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory; unless specified in the policy services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the policy should be assumed to apply equally to all Revenue Codes.

Revenue codes only apply to providers who bill these services to the fiscal intermediary or Part A MAC. Revenue codes do not apply to physicians, other professionals and suppliers who bill these services to the carrier or Part B MAC.

Please note that not all revenue codes apply to every type of bill code. Providers are encouraged to refer to the FISS revenue code file for allowable bill types. Similarly, not all revenue codes apply to each CPT/HCPCS code. Providers are encouraged to refer to the FISS HCPCS file for allowable revenue codes.

All revenue codes billed on the inpatient claim for the dates of service in question may be subject to review.

0321 Radiology - Diagnostic - Angiocardiology
0359 CT Scan - CT Other
 
 
CPT/HCPCS Codes 
CPT CODES 0144T-0151T ARE DELETED EFFECTIVE 12/31/2009 AND REPLACED BY CPT CODES 75571-75574 (BELOW)

CPT code 0144T is not a covered service (for dates of service prior to 01/01/2010.)

For dates of service on or after 01/01/2010, CPT code 75571 is not a covered service.

75571 COMPUTED TOMOGRAPHY, HEART, WITHOUT CONTRAST MATERIAL, WITH QUANTITATIVE EVALUATION OF CORONARY CALCIUM
75572 COMPUTED TOMOGRAPHY, HEART, WITH CONTRAST MATERIAL, FOR EVALUATION OF CARDIAC STRUCTURE AND MORPHOLOGY (INCLUDING 3D IMAGE POSTPROCESSING, ASSESSMENT OF CARDIAC FUNCTION, AND EVALUATION OF VENOUS STRUCTURES, IF PERFORMED)
75573 COMPUTED TOMOGRAPHY, HEART, WITH CONTRAST MATERIAL, FOR EVALUATION OF CARDIAC STRUCTURE AND MORPHOLOGY IN THE SETTING OF CONGENITAL HEART DISEASE (INCLUDING 3D IMAGE POSTPROCESSING, ASSESSMENT OF LV CARDIAC FUNCTION, RV STRUCTURE AND FUNCTION AND EVALUATION OF VENOUS STRUCTURES, IF PERFORMED)
75574 COMPUTED TOMOGRAPHIC ANGIOGRAPHY, HEART, CORONARY ARTERIES AND BYPASS GRAFTS (WHEN PRESENT), WITH CONTRAST MATERIAL, INCLUDING 3D IMAGE POSTPROCESSING (INCLUDING EVALUATION OF CARDIAC STRUCTURE AND MORPHOLOGY, ASSESSMENT OF CARDIAC FUNCTION, AND EVALUATION OF VENOUS STRUCTURES, IF PERFORMED)
 
 
ICD-9 Codes that Support Medical Necessity 
It is the responsibility of the provider to code to the highest level specified in the ICD-9-CM (e.g., to the fourth or fifth digit). The correct use of an ICD-9-CM code listed below does not assure coverage of a service. The service must be reasonable and necessary in the specific case and must meet the criteria specified in this determination.

164.1 MALIGNANT NEOPLASM OF HEART
198.89 SECONDARY MALIGNANT NEOPLASM OF OTHER SPECIFIED SITES
212.7 BENIGN NEOPLASM OF HEART
411.1 INTERMEDIATE CORONARY SYNDROME
411.81 ACUTE CORONARY OCCLUSION WITHOUT MYOCARDIAL INFARCTION
412 OLD MYOCARDIAL INFARCTION
413.9 OTHER AND UNSPECIFIED ANGINA PECTORIS
414.00 CORONARY ATHEROSCLEROSIS OF UNSPECIFIED TYPE OF VESSEL NATIVE OR GRAFT
414.01 CORONARY ATHEROSCLEROSIS OF NATIVE CORONARY ARTERY
414.02 CORONARY ATHEROSCLEROSIS OF AUTOLOGOUS VEIN BYPASS GRAFT
414.03 CORONARY ATHEROSCLEROSIS OF NONAUTOLOGOUS BIOLOGICAL BYPASS GRAFT
414.04 CORONARY ATHEROSCLEROSIS OF ARTERY BYPASS GRAFT
414.05 CORONARY ATHEROSCLEROSIS OF UNSPECIFIED BYPASS GRAFT
414.06 CORONARY ATHEROSCLEROSIS OF NATIVE CORONARY ARTERY OF TRANSPLANTED HEART
414.07 CORONARY ATHEROSCLEROSIS OF BYPASS GRAFT (ARTERY) (VEIN) OF TRANSPLANTED HEART
414.10 ANEURYSM OF HEART (WALL)
414.11 ANEURYSM OF CORONARY VESSELS
414.12 DISSECTION OF CORONARY ARTERY
414.19 OTHER ANEURYSM OF HEART
414.8 OTHER SPECIFIED FORMS OF CHRONIC ISCHEMIC HEART DISEASE
414.9 CHRONIC ISCHEMIC HEART DISEASE UNSPECIFIED
416.0 PRIMARY PULMONARY HYPERTENSION
423.0 HEMOPERICARDIUM
423.1 ADHESIVE PERICARDITIS
423.2 CONSTRICTIVE PERICARDITIS
423.3 CARDIAC TAMPONADE
423.8 OTHER SPECIFIED DISEASES OF PERICARDIUM
423.9 UNSPECIFIED DISEASE OF PERICARDIUM
424.0 MITRAL VALVE DISORDERS
424.1 AORTIC VALVE DISORDERS
427.31* ATRIAL FIBRILLATION
427.32* ATRIAL FLUTTER
427.41 VENTRICULAR FIBRILLATION
427.42 VENTRICULAR FLUTTER
441.01 DISSECTION OF AORTA THORACIC
441.1 THORACIC ANEURYSM RUPTURED
441.2 THORACIC ANEURYSM WITHOUT RUPTURE
745.10 COMPLETE TRANSPOSITION OF GREAT VESSELS
745.11 DOUBLE OUTLET RIGHT VENTRICLE
745.12 CORRECTED TRANSPOSITION OF GREAT VESSELS
745.19 OTHER TRANSPOSITION OF GREAT VESSELS
745.2 TETRALOGY OF FALLOT
745.3 COMMON VENTRICLE
745.4 VENTRICULAR SEPTAL DEFECT
745.5 OSTIUM SECUNDUM TYPE ATRIAL SEPTAL DEFECT
745.60 ENDOCARDIAL CUSHION DEFECT UNSPECIFIED TYPE
745.61 OSTIUM PRIMUM DEFECT
745.69 OTHER ENDOCARDIAL CUSHION DEFECTS
745.7 COR BILOCULARE
745.8 OTHER BULBUS CORDIS ANOMALIES AND ANOMALIES OF CARDIAC SEPTAL CLOSURE
745.9 UNSPECIFIED DEFECT OF SEPTAL CLOSURE
746.00 CONGENITAL PULMONARY VALVE ANOMALY UNSPECIFIED
746.01 ATRESIA OF PULMONARY VALVE CONGENITAL
746.02 STENOSIS OF PULMONARY VALVE CONGENITAL
746.09 OTHER CONGENITAL ANOMALIES OF PULMONARY VALVE
746.1 TRICUSPID ATRESIA AND STENOSIS CONGENITAL
746.2 EBSTEIN'S ANOMALY
746.3 CONGENITAL STENOSIS OF AORTIC VALVE
746.4 CONGENITAL INSUFFICIENCY OF AORTIC VALVE
746.5 CONGENITAL MITRAL STENOSIS
746.6 CONGENITAL MITRAL INSUFFICIENCY
746.7 HYPOPLASTIC LEFT HEART SYNDROME
746.81 SUBAORTIC STENOSIS CONGENITAL
746.82 COR TRIATRIATUM
746.83 INFUNDIBULAR PULMONIC STENOSIS CONGENITAL
746.84 CONGENITAL OBSTRUCTIVE ANOMALIES OF HEART NOT ELSEWHERE CLASSIFIED
746.85 CORONARY ARTERY ANOMALY CONGENITAL
746.87 MALPOSITION OF HEART AND CARDIAC APEX
746.89 OTHER SPECIFIED CONGENITAL ANOMALIES OF HEART
746.9 UNSPECIFIED CONGENITAL ANOMALY OF HEART
747.0 PATENT DUCTUS ARTERIOSUS
747.10 COARCTATION OF AORTA (PREDUCTAL) (POSTDUCTAL)
747.11 INTERRUPTION OF AORTIC ARCH
747.20 CONGENITAL ANOMALY OF AORTA UNSPECIFIED
747.21 CONGENITAL ANOMALIES OF AORTIC ARCH
747.22 CONGENITAL ATRESIA AND STENOSIS OF AORTA
747.29 OTHER CONGENITAL ANOMALIES OF AORTA
747.3 CONGENITAL ANOMALIES OF PULMONARY ARTERY
747.40 CONGENITAL ANOMALY OF GREAT VEINS UNSPECIFIED
747.41 TOTAL ANOMALOUS PULMONARY VENOUS CONNECTION
747.42 PARTIAL ANOMALOUS PULMONARY VENOUS CONNECTION
747.49 OTHER ANOMALIES OF GREAT VEINS
786.50 UNSPECIFIED CHEST PAIN
786.51 PRECORDIAL PAIN
786.59 OTHER CHEST PAIN
794.30 UNSPECIFIED ABNORMAL FUNCTION STUDY OF CARDIOVASCULAR SYSTEM
794.39 OTHER NONSPECIFIC ABNORMAL FUNCTION STUDY OF CARDIOVASCULAR SYSTEM
V53.31 FITTING AND ADJUSTMENT OF CARDIAC PACEMAKER
*Coverage for these diagnoses is limited to patients in whom ablation for these dysrhythmias has already been planned and scheduled.
 
 
Diagnoses that Support Medical Necessity 
Not applicable 
 
ICD-9 Codes that DO NOT Support Medical Necessity 
Not applicable

XX000 Not Applicable
 
 
ICD-9 Codes that DO NOT Support Medical Necessity Asterisk Explanation 
 
 
Diagnoses that DO NOT Support Medical Necessity 
Not applicable
 


General Information

 
Documentation Requirements 
The patient's medical record must contain documentation that fully supports the medical necessity for services included within this LCD. (See "Indications and Limitations of Coverage.") This documentation includes, but is not limited to, relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures.

Each claim must be submitted with ICD-9-CM codes that reflect the condition of the patient, and indicate the reason(s) for which the service was performed. Claims submitted without ICD-9-CM codes will
be returned.

The documentation of the study requires a formal written report, with clear identifying demographics, the name of the interpreting provider, the reason for the tests, an interpretive report and copies of images. The computerized image reconstruction data should also be maintained.

Documentation must be available to Medicare upon request.
 
 
Appendices 
 
 
Utilization Guidelines 
The frequency of the exam must be reasonable and justified by the course of the patient’s illness. 
 
Sources of Information and Basis for Decision 
This bibliography presents those sources that were obtained during the development of this policy. National Government Services is not responsible for the continuing viability of Web site addresses listed below.

  1. Achenbach S, Giesler T, Ropers D, et al. Detection of coronary artery stenoses by contrast-enhanced, retrospectively electrocardiographically-gated, multislice spiral computed tomograhy. Circulation Journal [serial on line]. May 2001.
  2. ACR practice guideline for the performance of computed tomography (CT) for the detection of pulmonary embolism in adults. ACR Practice Guideline CT Pulmonary Embolism.2000; 8:189-192. Revised 2005;27. Effective 10/01/2005.
  3. ACR practice guideline for the performance and interpretation of CT Angiography (CTA). ACR Practice Guideline CT Angiography. 2005; 30:271-274. Amended 2006;17,35. Effective 10/01/05.
  4. Budoff MJ, Achenbach S, Duerinckx A, et al. Clinical utility of computed tomography and magnetic resonance techniques for noninvasive coronary angiography. The American Journal of Cardiology [serial on line]. November 2003;42.
  5. Budoff MJ, Achenbach S, Blumenthal, J, et al. Assessment of coronary artery disease by cardiac computed tomography: a scientific statement from the American Heart Association Committee on cardiovascular imaging and intervention, council on cardiovascular radiology and intervention, and Committee on Cardiac Imaging, Council on Clinical Cardiology. Circulation. October 2006;114;1761-1791.
  6. Budoff MJ, Cohen MC, Garcia MJ, et al. ACCF/AHA clinical competence statement on cardiac imaging with computed tomography and magnetic resonance: a report of the American College of Cardiology Foundation/American Heart Association/American College of Physicians Task Force on clinical competence and training (ACC/AHA Committee on CV Tomography). J Am Coll Cardiol. 2005;46:388–402.
  7. Chiles C, Carr JJ. Vascular diseases of the thorax: evaluation with multidetector CT. Radiologic Clinics of North America [serial on line]. May 2005;43;3.
  8. de Feyter PJ, van Pelt N. Spiral computed tomography coronary angiography: a new diagnostic tool developing its role in clinical cardiology, editorial. Journal of the American College of Cardiology. 2007;49;872-874.
  9. Ehara M, Kawai M, Surmely JF, et al. Diagnostic accuracy of coronary in-stent restenosis using 64-slice computed tomography. Journal of the American College of Cardiology. 2007;49:951-959.
  10. Gaspar T, Halon DA, Lewis BS, et al. Diagnosis of coronary in-stent restenosis with multidetector row spiral computed tomography. Journal of the American College of Cardiology. 2005;46:1573-1579.
  11. Goldstein JA, Gallagher MJ, O’Neill WW, et al. A randomized controlled trial of multislice coronary computed tomography for evaluation of acute chest pain. Journal of the American College of Cardiology. 2007;49:863-871.
  12. Hausleiter J, Meyer T, Hadmitzky M, et al. Prevalence of noncalcified plaques by 64-slice computed tomography in patients with an immediate risk for significant coronary artery disease. Journal of the American College of Cardiology. 2006;48:312-318.
  13. Hendel RC, Patel MR, Kramer CM, et al. ACCF/ACR/SCMR/ASNC/NASCI/SCAI/SIR Appropriateness criteria for cardiac computed tomography and cardiac magnetic resonance imaging. Journal of the American College of Cardiology. 2006;48:1475-1497.
  14. Hoffman U, Moselewski F, Cury RC, et al. Predictive value of 16-slice multidetector spiral computed tomography to detect significant obstructive coronary disease in patients at high risk for coronary artery disease. Patient- Versus Segment-Based Analysis. Circulation. 2004;110:2638-2643.
  15. Jongbloed MRM, Lamb HJ, Bax JJ, et al. Noninvasive visualization of the cardiac venous system using multislice computed tomography. Journal of the American College of Cardiology. 2005;45:749-753.
  16. Kopp AF, Schroeder S, Kuettner A, et al. Non-invasive coronary angiography with high resolution multidetector-row computed tomography. The European Society of Cardiology. Elsevier Science Ltd. European Heart Journal. 2002;23:1714-1725.
  17. Kuettner A, Beck T, Drosch T, et al. Diagnostic accuracy of noninvasive coronary imaging using 16-detector slice spiral computed tomography with 188ms temporal resolution. Journal of the American College of Cardiology. 2005;45:123-127.
  18. Lardo AC, Cordeiro MA, Silva C, et al. Contrast-enhanced multidetector computed tomography viability imaging after myocardial infarction. Characterization of myocyte death, microvascular obstruction, and chronic scar. Circulation. 2006;113:394-404.
  19. Lawler LP, Fishman EK. Multi-detector row CT of thoracic disease with emphasis on 3D volume rendering and CT angiography. RadioGraphics. 2001;21:1257-1273.
  20. Leber AW, Kenz A, von Ziegler F, et al. Quantification of obstructive and nonobstructive coronary lesions by 64-slice computed tomography. Journal of the American College of Cardiology. 2005;46:147-154.
  21. Lewis B, Halon D. Integrating multidetector computed tomography into clinical practice. Editorial. Journal of the American College of Cardiology. 2007;49:960-962.
  22. Matchar DB, Mark DB, Patel MR, et al. Technology assessment: non-invasive imaging for coronary artery disease. AHRQ Technology Assessment Program. October 3, 2006.
  23. Meyer TS, Martinoff S, Hadamitzky M, et al. Improved noninvasive assessment of coronary artery bypass grafts with 64-slice computed tomographic angiography in an unselected patient population. Journal of the American College of Cardiology. 2007;49:946-950.
  24. Mollet NR, Cademartiri F, van Mieghem CA, et al. High-resolution spiral computed tomography coronary angiography in patients referred for diagnostic convential coronary angiography. Circulation. 2005;112:2318-2323.
  25. Mollet NR, Cademartiri F, Krestin GP, et al. Improved diagnostic accuracy with 16-row multi-slice computed tomography coronary angiography. Journal of the American College of Cardiology. 2005;45:128-132.
  26. Narevic E, Schoenbert NE. Lay explanations for Kentucky's "Coronary Valley". J Community Health. 2002 Feb;27(1):53-62.
  27. Moussa I, Jones M, Kereiakes DJ, et al. Stone Cardiovascular Research Foundation, Lenox Hill Heart & Vascular Institute of New York. Does culprit lesion calcification affect the performance of the Paclitaxel-Eluting Stent? A TAXUS-IV Substudy. Am J Cardiol. 2004;94(suppl 6A):66E.
  28. Pijls NH, van Schaardenburgh P. Percutaneous coronary intervention of functionally nonsignificant stenosis: 5-year follow-up of the DEFER Study. Am J Cardiol. 2007;49(21):2105-11.
  29. Raff GL, Gallagher MJ, O’Neill WW, et al. Diagnostic accuracy of noninvasive coronary angiography using 64-slice spiral computed tomography. Journal of the American College of Cardiology. 2005;46:552-557.
  30. Raman SV, Shah M, McCarthy B, et al. Multi-detector row cardiac computed tomography accurately quantifies right and left ventricular size and function compared with cardiac magnetic resonance. American Heart Journal. 2006;151;3:736-744.
  31. Redberg RF. Evidence, appropriateness, and technology assessment in cardiology: A case study of computed tomography. Health Affairs. 2007;27;86-95. 10.1377/hlthaff.26.1.86.
  32. Romeo G, Houyel L, Angel CY, et al. Coronary stenosis detection by 16-slice computed tomography in heart transplant patients. Journal of the American College of Cardiology 2005;45:1826-1831.
  33. Ropers D, Baum U, Pohle K, et al. Detection of coronary artery stenoses with thin-slice multi-detector row spiral computed tomography and multiplanar reconstruction. Circulation Journal [serial on line]. February 2003.
  34. Ropers D, Rixe J. Usefulness of multidetector row spiral computed tomography with 64- x 0.6-mm collimation and 330-ms rotation for the noninvasive detection of significant coronary artery stenoses. Am J Cardiol. 2006 Feb 1;97(3):343-8.
  35. Rubinshtein R, Halon D, Gaspar T, et al. Usefulness of 64-slice cardiac computed tomographic angiography for diagnosing acute coronary syndromes and predicting clinical outcome in emergency department patients with chest pain of uncertain origin. Circulation. 2007;115;1762-1768.
  36. Sato U, Matsumoto N, Kato M, et al. Noninvasive assessment of coronary artery disease by multislice spiral computed tomography using a new retrospectively ECG-gated image reconstruction technique – comparison with angiopgraphic results. Circulation Journal, [serial on line]. May 2003;67.
  37. Schindler TH, Magosaki N, Jeserich M, et al. 3D assessment of myocardial perfusion parameter combined with 3D reconstructed coronary artery tree from digital coronary angiograms. International Journal of Cardiac Imaging. 2000;16:1-12.
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  39. Schroeder S, Kopp AF, Baumbach A, et al. Non-invasive characterization of coronary lesion morphology by multislice computed tomography: a promising new technology for risk stratification of patient with coronary artery disease. @ http://heart.bmjjournals.com/cgi/contebt/full/85/5/576a
  40. Schuijf JD, Pundziute G, Jukema JW, et al. Diagnostic accuracy of 64-slice multislice computed tomography in the noninvasive evaluation of significant coronary artery disease. American Journal of Cardiology. 2006;98:145-148.
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  42. Shapiro M, Butler J. Analytic approaches to establish the diagnostic accuracy of coronary computed tomography angiography as a tool for clinical decision making. Am J Cardiol. 2007;Apr 15;99(8):1122-7.
  43. Tobis J. A non-biased assessment of the usefulness of computed tomographic angiography. Am J Cardiol. 2007;Apr 15;99(8):1165.
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    Model Local Coverage Determination (LCD) Work Group for Cardiac Computed Tomography (CCT) and Computed Tomography Coronary Angiography (CTCA), comprising of the American College of Cardiology (ACC), Carrier Advisory Committee (CAC), American College of Radiology (ACR), American Society of Nuclear Cardiology (ASNC), North American Society for Cardiac Imaging (NASCI) Society of Cardiac Angiography and Intervention (SCAI) and Society of Cardiovascular CT (SCCT), which had the following sources:
  • American College of Cardiology Foundation (ACCF)/American Heart Association (AHA) clinical competence statement on cardiac imaging with computed tomography and magnetic resonance. JACC. 2005;46;2;383-402.
  • American College of Radiology Clinical Statement on Noninvasive Cardiac Imaging. Radiology. 2005;235:723–727.
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  • Cademartiri F, Nieman K, van der Lugt A, et al. Intravenous contrast material administration at 16-detector row helical CT coronary angiography: test bolus versus bolus-tracking technique. Radiology. 2004;233:817-823.
  • Chiurlia E, Menozzi M, Ratti C, et al. Follow-up of coronary artery bypass graft patency by multislice computed tomography. Am J Cardio. 2005;95(9):1094-1097.
  • Contractor S, Maldjian PD, Sharma VK, et al. Role of helical CT in detecting right ventricular dysfunction secondary to acute pulmonary embolism. J Comput Assist Tomogr. 2002;26(4):587-91.
  • Cronin P, Sneider M, Kazerooni EA, et al. Imaging of the left atrium and pulmonary veins in planning for radiofrequency ablation for atrial fibrillation: a how to guide. American Journal of Roentgenology. 2004;183:767-778.
  • Cui W, Anno H, Kondo T, et al. Right ventricular volume measurement with singleplane Simpson's method based on a new half-circle model. Int J Cardiol. 2004;94(2-3):289-92.
  • Datta J, White CS, Gilkeson RC, et al. Anomalous coronary arteries in adults: depiction at multi-detector row CT angiography. Radiology. 2005;235:812-818.
  • Deibler AR, Kuzo RS, Vohringer M, et al. Imaging of congenital coronary anomalies with multislice computed tomography. Mayo Clin Proc. 2004;79:1017-1023.
  • Desjardins B, Kazerooni EA. ECG-gated cardiac CT. American Journal of Roentgenology, 2004;182:993-1010.
  • Funabashi N, Kobayashi Y, Kudo M, et al. New method of measuring coronary diameter by electron-beam computed tomographic angiography using adjusted thresholds determined by calibration with aortic opacity. Circ J. 2004;68:769-777.
  • Funabashi N, Kobayashi Y, Perlroth M, et al. Coronary Artery: Quantitative Evaluation of Normal Diameter Determined with Electron-Beam CT Compared with Cine Coronary Angiography Initial Experience. Radiology. 2003;226:263-271.
  • Gerber BL, Coche E, Pasquet A, et al. Coronary artery stenosis: direct comparison of four-section multi-detector row CT and 3D navigator MR imaging for detection-initial results. Radiology. 2005.
  • Herzog C, Dogan S, Diebold T, et al. Multi-detector row CT versus coronary angiography: preoperative evaluation before totally endoscopic coronary artery bypass grafting. Radiology. 2003;229:200-208.
  • Hoffmann MH, Shi H, Schmitz BL, et al. Noninvasive coronary angiography with multislice computed tomography. JAMA. 2005;293:2471-2478.
  • Hofmann LK, Zou KH, Costello P, et al. Electrocardiographically gated 16- section CT of the thorax: cardiac motion suppression. Radiology. 2004;233:927-933.
  • Hong C, Chrysant GS, Woodard PK, et al. Coronary artery stent patency assessed with in-stent contrast enhancement measured at multi-detector row CT angiography: initial experience. Radiology. 2004;233:286-291.
  • Hundt W, Siebert K, Wintersperger BJ, et al. Assessment of global left ventricular function: comparison of cardiac multidetector-row computed tomography with angiocardiography. J Comput Assist Tomogr. 2005;29:373-381.
  • Jaber W, White RD, Kuzmiak SK, et al. Comparison of ability to identify left atrial thrombus by three-dimensional tomography versus transesophageal echocardiography in patients with atrial fibrillation. Am J Cardiol. 2004;93(4):486-9.
  • Jongbloed MR, Bax JJ, Lamb HJ, et al. Multislice computed tomography versus intracardiac echocardiography to evaluate the pulmonary veins before radiofrequency catheter ablation of atrial fibrillation: a head-to-head comparison. J Am Coll Cardiol. 2005;45(3):343-50.
  • Jongbloed MR, Bax JJ, Lamb HJ, et al. Noninvasive visualization of the cardiac venous system using multislice computed tomography. J Am Coll Cardiol. 2005;45(5):749-53.
  • Kaklikkaya I, Yeginoglu G. Damage to coronary arteries during mitral valve surgery. Heart Surg Forum 2003; 6:E138-42.
  • Khouzam R, Marshal T, Lowell D, et al. Left coronary artery originating from right sinus of Valsalva with diagnosis confirmed by CTa case report. Angiology. 2003;54:499-502.
  • Kimura F, Saki F, Sakomura Y, et al. Helical CT features of arrhythmogenic right ventricular cardiomyopathy. Radiographics. 2002;22(5):1111-24. Review.
  • Kimura S, Kakuta T, Kuboyama O, et all. Multislice computed tomography for risk stratification in patients with suspected non ST segment elevation acute coronary syndrome. Circulation. 2004;110(Suppl III):abstract 2449.
  • Kuettner A, Trabold T, Schroeder S, et al. Noninvasive detection of coronary lesions using 16-detector multislice spiral computed tomography technology: initial clinical results. J Am Coll Cardiol. 2004;44:1230-1237.
  • Lacomis JM, Wigginton, W, Fuhrman C, et al. Multi-detector row CT of the left atrium and pulmonary veins before radio-frequency catheter ablation for atrial fibrillation. Radiographics. 2003;23 Spec No:S35-48;discussion S48-50. Review.
  • Langheinrich AC, Bohle RM, Greschus S, et al. Atherosclerotic lesions at micro CT: feasibility for analysis of coronary artery wall in autopsy specimens. Radiology. 2004;231:675-681.
  • Lau GT, Ridley JT, Schieb MC, et al. Coronary artery stenoses: detection with calcium scoring, CT angiography, and both methods combined. Radiology,. 2005;235:415-422.
  • Lemola K, Desjardins B, Sneider M, et al. Effect of left atrial circumferential ablation for atrial fibrillation on left atrial transport function. Heart Rhythm. 2005;2:923-928.
  • Lemola K, Sneider M, Desjardins B, et al. Computerized tomographic analysis of the anatomy of the left atrium and the esophagus: implications for left atrial catheter ablation. Circulation. 2004;110:3655-3660.
  • Lemola K, Mueller G, Desjardins B, et al. Topographic analysis of the coronary sinus and major cardiac veins by computed tomography. Heart Rhythm. 2005;2:694-699.
  • Leschka S, Alkadhi H, Plass A, et al. Accuracy of MSCT coronary angiography with 64 slice technology: first experience. Eur Heart J. [serial on line]. April 2005.
  • Lessick J, Kummar C, Beyar R, et al. Anomalous origin of a posterior descending artery from the right pulmonary artery: report of a rare case diagnosed by multidetector computed tomography angiography. J Comput Assist Tomogr. 2004;28:857-859.
  • Lida K, Sata Y, Matsumoto N, et al. Usefulness of multislice computed tomography to identify acute coronary syndrome in the emergency department. Circulation. 2004;110 (Supple III):abstract 2100.
  • Lu B, Zhuang N, Mao SS, et al. Baseline heart rate-adjusted electrocardiographic triggering for coronary artery electron-beam CT angiography. Radiology. 2004;233:590-595.
  • Marom EM, Herndon JE, Kim YH, et al. Variations in pulmonary venous drainage to the left atrium: implications for radiofrequency ablation. Radiology. [serial on line]. 2004;230(3):824-9.
  • Martuscelli E, Romagnoli A, D’Eliseo A, et al. Evaluation of venous and arterial conduit patency by 16-slice spiral computed tomography. Circulation. 2004;110(20):3234-2328.
  • Nanthakumar K, Mountz JM, Plumb VJ, et al. Functional assessment of pulmonary vein stenosis using radionuclide ventilation/perfusion imaging. Chest. 2004 Desjardins B, ;126(2):645-51.
  • Nieman K, Pattynama PM, Rensing BJ, et al. Evaluation of patients after coronary artery bypass surgery: CT angiographic assessment of grafts and coronary arteries. Radiology. 2003;29:749-756.
  • Perez-Lugones A, Schvartzman PR, Schweikert R, et al. Three-dimensional reconstruction of pulmonary Veins in patients with atrial fibrillation and controls: morphological characteristics of different veins. Pacing Clin Electrophysiol. 2003;26;1:8-15.
  • Pope JH, Aufderheide TP, Ruthazaer R, et al. Missed diagnoses of acute cardiac ischemia in the emergency department. N Engl J Med. 2000;342:1163-70.
  • Raff GL, Gallagher MJ, O’Neill WW, et al. Diagnostic accuracy of noninvasive coronary angiography using 64-slice spiral computed tomography. J Am Coll Cardiol. 2005;46:552-557.
  • Ramsdale DR, Bennett DH, Bray CL, et al. Angina, coronary risk factors and coronary artery disease in patients with valvular disease. A prospective study. Eur Heart J.
  • Ropers D, Moshage W, Daniel WG, et al. Visualization of coronary artery anomalies and their course by contrast-enhanced electron beam tomography and three-dimensional reconstruction. Am J Cardiol. 2001;87:193-197.
  • Saad EB, Cole CR, Marrouche NF, et al. Use of Intracardiac echocardiography for prediction of chronic pulmonary vein stenosis after ablation of atrial fibrillation. J Cardiovasc Electrophysiol. 2002;13(10):986-9.
  • Scharf C, Sneider M, Case I, et al. Anatomy of the pulmonary veins in patients with atrial fibrillation and effects of segmental ostial ablation analyzed by computed tomography. Journal of Cardiovascular Electrophysiology. 2003;14:150-155.
  • Schlosser T, Konorza T, Hunold P, et al. Noninvasive Visualization of Coronary Artery Bypass Grafts Using 16-Detector Row Computed Tomography. J Am Coll Cardiol. 2004;44:1224-1229.
  • Schoenhagen P, Halliburton SS, Stillman AE, et al. Noninvasive imaging of coronary arteries: current and future role of multi-detector row CT. Radiology. 2004;232:7-17.
  • Schoepf UJ, Becker CR, Ohnesorge BM, et al. CT of coronary artery disease. Radiology. 2004;232:18-37.
  • Schoepf UJ, Kucher N, Kipfmueller F, et al. Right ventricular enlargement on chest computed tomography: a predictor of early death in acute pulmonary embolism. Circulation. 2004;110(20):3276-80.
  • Schwartzman D, Lacomis, J, Wigginton WG, et al. Characterization of left atrium and distal pulmonary vein morphology using multidimensional computed tomography. J Am Coll Cardiol. 2003;41(8):1349-57.
  • Setser RM, O’Donnell TP, Smedira NG, et al. Coregistered MR imaging myocardial viability maps and multi-detector row CT coronary angiography displays for surgical revascularization planning: initial experience. Radiology. 2005;237:465-473.
  • Shi H, Aschoff AJ, Brambs HJ, et al. Multislice CT imaging of anomalous coronary arteries. Eur Radiol. 2004;14:2172-81.
  • Singh JP, Houser S, Heist EK, et al. The coronary venous anatomy: A Segmental approach to aid cardiac resynchronization therapy. J Am Coll Cardiol. 2005;46:68-74.
  • Tada H, Nogami A, Naito S, et al. Arrhythmogenic right ventricular cardiomyopathy with regional left ventricular involvement. J Cardiovasc Electrophysiol. 1999;10(5):762.
  • Tavilla G and Pacini D. Damage to the circumflex coronary artery during mitral valve repair with sliding leaflet technique. Ann Thorac Surg. 1998;66:2091-3.
  • van Ooijen PM, Dorgelo J, Zijlstra F, et al. Detection, visualization and evaluation of anomalous coronary anatomy on 16-slice multidetector-row CT. Eur Radiol. 2004;14(12):2163-71.
  • Virmani R, Chun PK, Parker J, et al. J Thorac Cardiovasc Surg. 1982;84:773-8.
  • Weinreb et al. American College of Radiology Clinical Statement on Noninvasive Cardiac Imaging. JACR. 2005;2:471-477.
  • Willmann JK, Weishaupt D, Kobza R, et al. Coronary artery bypass grafts: ECG-gated multi-detector row CT angiography-influence of image reconstruction interval on graft visibility. Radiology. 2004;232:568-577.
  • Wood MA, Wittkamp M, Henry D, et al. A comparison of pulmonary vein ostial anatomy by computerized tomography, echocardiography, and venography in patients with atrial fibrillation having radiofrequency catheter ablation. Am J Cardiol. 2004;93(1):49-53.
  • Yamamuro M, Tadamura E, Kubo S, et al. Cardiac functional analysis with multidetector row CT and segmental reconstruction algorithm: comparison with echocardiography, SPECT, and MR imaging. Radiology. 2005;234:381-390.
  • Zapolski T, Wysokinski A, Przegalinski J, et al. Coronary atherosclerosis in patients with acquired valvular disease. Kardiol Pol. 2004;61:534-43.


 
 
Advisory Committee Meeting Notes 
Carrier Advisory Committee Meeting Date(s):
06/13/2007 New Jersey and New York
06/25/2007 Indiana
06/28/2007 Kentucky

This coverage determination does not reflect the sole opinion of the contractor or contractor medical director. Although the final decision rests with the contractor, this determination is developed in consultation with representatives from Advisory Committee members and/or from various state and local provider organizations.

Any Carrier Advisory Committee (CAC) related information, including Start Date and End Date of Comment Period, reflects the last time this LCD passed through the Comment and Notice process. Formal comment is not required for LCDs being adopted as part of the MAC transition.

 
 
Start Date of Comment Period 
06/01/2007 
 
End Date of Comment Period 
07/15/2007 
 
Start Date of Notice Period 
01/01/2011 
 
Revision History Number 
R6 
 
Revision History Explanation 
R6 (effective 01/01/2011): Annual LCD review per CMS Program Integrity Manual, Chapter 13, Section 13.4[C]. The references in the “CMS National Coverage Policy” section and the coding requirements in the LCD were reviewed. Minor template changes were made to reflect current template language. No comment and notice periods required and none given.

R5 (effective 01/01/2010): Annual HCPCS code update for 2010: CPT codes 0144T-0151T have been deleted and replaced by codes 75571-75574 effective 01/01/2010. Information added on bill type for reporting FQHC services. Minor formatting changes made. No comment or notice periods required and none given.

R4 (effective 09/01/2009): Source of revision- Internal. It has been clarified in the “Limitations” and in the “CPT/HCPCS Codes” sections CPT code 0144T is not a covered service. Minor changes made to reflect current template language. No additional comment or notice periods required and none given.

06/05/2009 - In accordance with Section 911 of the Medicare Modernization Act of 2003, fiscal intermediary number 00270 was removed from this LCD as the claims processing for New Hampshire and Vermont was transitioned to NHIC, the Part A/Part B MAC contractor in these states.

05/15/2009 - In accordance with Section 911 of the Medicare Modernization Act of 2003, fiscal intermediary numbers 00180 and 00181 were removed from this LCD as the claims processing for Maine and Massachusetts was transitioned to NHIC, the Part A/Part B MAC contractor in these states.

R3: Source of revision-External (reconsideration) ICD-9-CM Code 794.39, Nonspecific abnormal results of function studies; Cardiovascular; other, added to the list of ICD-9 Codes that Support Medical Necessity. This addition is effective 10/18/2008 although revision is dated 12/01/2008. No comment and notice periods required and none given.

R2: This revised LCD is effective for all National Government Services jurisdictions on July 18, 2008 with these exceptions: for Connecticut – Part B the LCD is effective on August 1, 2008; for Upstate New York – Part B, the LCD is effective on September 1, 2008; and for New York and Connecticut – Part A, the LCD is effective on November 14, 2008. For New York – Part A (contract 00308), the content of this LCD is currently in effect but the LCD will be transferred to the J-13 contract number 13201 on November 14, 2008.

This LCD was revised to add the Jurisdiction 13 (J-13) MAC contractor numbers.

The CMS Statement of Work for the J13 Medicare Administrative Contract (MAC) requires that the contractor retain the most clinically appropriate LCD within the jurisdiction. This NGS policy is being promulgated to the J13 MAC as the most clinically appropriate LCD within that jurisdiction.

The NGS roster of LCDs has been developed under the combined experience of seven Medicare contractor medical directors. The criteria for inclusion in this roster includes areas of identified CERT errors, especially repetitive errors; high volume/high dollar/pervasive problems; patient safety issues; potential for automation; beneficiary access to new technology; implementation of NCD; narrative medical necessity parameters for medical review and provider education; and CMS/law enforcement mandates.

NGS LCDs have undergone an advice and comment process from the providers in 23 states. This advice and comment process, the most comprehensive among all Medicare contractors, has ensured that NGS policies have benefited from the most in-depth and scientifically rigorous scrutiny. The NGS policy development process has resulted in the most clinically appropriate LCDs for providers and Medicare beneficiaries.

R1:As a result of the annual HCPCS update, the descriptions for CPT codes 0144T-0151T have been revised in the "CPT/HCPCS Codes" section.
Although this revision was done on 03/01/2008, the changes described above are effective for dates of service on or after 01/01/2008.
Date Posted: 03/01/2008

11/14/2008 - In accordance with Section 911 of the Medicare Modernization Act of 2003, fiscal intermediary number 00308 is removed from this LCD. Effective on this date, claims processing for Delaware is performed by Highmark Medicare Services, the Part A/Part B MAC contractor for this state, and the claims processing for New York and Connecticut is performed by National Government Services under the J-13 MAC contract; carrier number 00805 is removed, and claims processing for New Jersey is performed by Highmark Medicare Services, the Part A/Part B MAC contractor for this state.

08/18/2008 - In accordance with Section 911 of the Medicare Modernization Act of 2003, fiscal intermediary number 00454 was removed from this LCD as the claims processing for American Samoa, California, Guam, Hawaii, Nevada and Northern Mariana Islands was transitioned to Palmetto GBA, the Part A/Part B MAC contractor in these states.

11/15/2009 - CPT/HCPCS code 0144T was deleted from group 1
11/15/2009 - CPT/HCPCS code 0145T was deleted from group 1
11/15/2009 - CPT/HCPCS code 0146T was deleted from group 1
11/15/2009 - CPT/HCPCS code 0147T was deleted from group 1
11/15/2009 - CPT/HCPCS code 0148T was deleted from group 1
11/15/2009 - CPT/HCPCS code 0149T was deleted from group 1
11/15/2009 - CPT/HCPCS code 0150T was deleted from group 1
11/15/2009 - CPT/HCPCS code 0151T was deleted from group 1

3/7/2010 - The description for Bill Type Code 73 was changed
3/7/2010 - The description for Bill Type Code 77 was changed

8/1/2010 - The description for Bill Type Code 11 was changed
8/1/2010 - The description for Bill Type Code 12 was changed
8/1/2010 - The description for Bill Type Code 13 was changed
8/1/2010 - The description for Bill Type Code 73 was changed
8/1/2010 - The description for Bill Type Code 85 was changed

8/1/2010 - The description for Revenue code 0321 was changed
8/1/2010 - The description for Revenue code 0359 was changed

11/21/2010 - For the following CPT/HCPCS codes either the short description and/or the long description was changed. Depending on which description is used in this LCD, there may not be any change in how the code displays in the document:
75573 descriptor was changed in Group 1 
 
Reason for Change 
Maintenance (annual review with new changes, formatting, etc.)
 
Last Reviewed On Date 
01/01/2011 
 
Related Documents 
Article(s)
A45020 - Cardiac Computed Tomography (CCT) and Coronary Computed Tomography Angiography (CCTA) - Supplemental Instructions Article
 
LCD Attachments 
There are no attachments for this LCD