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«PacifiCare’s medical management guidelines represent the recommendation of the PacifiCare Medical Management Guideline (MMG) committee. They are ...»

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American College of Radiology (ACR). ACR practice guideline for the performance and interpretation of cardiac computed tomography (CT). October 2006b. Available at: http://www.acr.org/SecondaryMainMenuCategories/ quality_safety/guidelines/dx/cardio/ct_cardiac.aspx. Accessed April 7, 2009.

American College of Radiology (ACR). ACR appropriateness criteria for congestive heart failure. 2006c Available at:

http://www.acr.org/SecondaryMainMenuCategories/quality_safety/app_criteria/pdf/ ExpertPanelonCardiovascularImaging/CongestiveHeartFailureDoc10.aspx. Accessed April 7, 2009.

Andreini D, Pontone G, Pepi M, et al. Diagnostic accuracy of multidetector computed tomography coronary angiography in patients with dilated cardiomyopathy. J Am Coll Cardiol. 2007 May 22;49(20):2044-50. Epub 2007 May 4.

Blue Cross Blue Shield Association. Technology Evaluation Center (TEC) Assessment. Contrast-enhanced cardiac computed tomographic angiography in the diagnosis of coronary artery stenosis or for evaluation of acute chest pain.

Chicago (IL): Blue Cross Blue Shield Association; 2006 Aug. TEC Assessment Program; Volume 21, No. 5. Available at: http://www.bcbs.com/ Cardiac Computed Tomography (CT), Coronary Artery Calcium Scoring and Cardiac CT Angiography - Commercial Medical Management Guideline blueresources/tec/vols/21/21_05.pdf. Accessed April 7, 2009.

Brown ER, Kronmal RA, Bluemke DA, et al. Coronary calcium coverage score: determination, correlates, and predictive accuracy in the Multi-Ethnic Study of Atherosclerosis. Radiology. 2008 Jun;247(3):669-75. Epub 2008 Apr 15.

Budoff MJ, Dowe D, Jollis JG, et al. Diagnostic performance of 64-multidetector row coronary computed tomographic angiography for evaluation of coronary artery stenosis in individuals without known coronary artery disease: results from the prospective multicenter ACCURACY (Assessment by Coronary Computed Tomographic Angiography of Individuals Undergoing Invasive Coronary Angiography) trial. J Am Coll Cardiol. 2008 Nov 18;52(21):1724-32.

Budoff MJ, Achenbach S, Blumenthal RS, 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. 2006 Oct 17;114(16):1761-91.

Budoff MJ, Diamond GA, Raggi P, et al. Continuous probabilistic prediction of angiographically significant coronary artery disease using electron beam tomography Circulation 2002;105:1791-1796.

Detrano R, Guerci AD, Carr JJ, et al. Coronary calcium as a predictor of coronary events in four racial or ethnic groups.

N Engl J Med. 2008 Mar 27;358(13):1336-45.

Detrano RC, Anderson M, Nelson J, et al. Coronary calcium measurements: effect of CT scanner type and calcium measure on rescan reproducibility--MESA study. Radiology. 2005 Aug;236(2):477-84.

ECRI Institute. Emerging Technology (TARGET) Evidence Report. Multislice computed tomography (MSCT) scanners (overview). August 2008.

ECRI Institute. Health Technology Forecast. Multislice computed tomography angiography to detect coronary artery disease. August 2007a.

ECRI Institute. CT--how many ways should you slice it? Why 64 slices may be more than you need. Health Devices.

2007b Apr;36(4):107-23.

ECRI Institute. Emerging Technology (TARGET) Evidence Report. Electron-beam computed tomography (EBCT) for coronary artery disease (CAD) screening. August 2004.

Fleisher LA, Beckman JA, Brown KA, et al. ACC/AHA 2007 guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines developed in collaboration with the American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, and Society for Vascular Surgery. J Am Coll Cardiol. 2007 Oct 23;50(17):e159-241.

Ghostine S, Caussin C, Habis M, et al. Non-invasive diagnosis of ischaemic heart failure using 64-slice computed tomography. Eur Heart J. 2008 Apr 1. [Epub ahead of print] Gibbons RJ, Balady GJ, Bricker JT, et al. ACC/AHA 2002 guideline update for exercise testing: summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.

Circulation 2002;106:188392.

Cardiac Computed Tomography (CT), Coronary Artery Calcium Scoring and Cardiac CT Angiography - Commercial Medical Management Guideline Greenland P, Bonow RO, Brundage BH, et al. ACCF/AHA 2007 clinical expert consensus document on coronary artery calcium scoring by computed tomography in global cardiovascular risk assessment and in evaluation of patients with chest pain: a report of the American College of Cardiology Foundation Clinical Expert Consensus Task Force (ACCF/AHA Writing Committee to Update the 2000 Expert Consensus Document on Electron Beam Computed Tomography) developed in collaboration with the Society of Atherosclerosis Imaging and Prevention and the Society of Cardiovascular Computed Tomography. J Am Coll Cardiol. 2007 Jan 23;49(3):378-402.

Greenland P, LaBree L, Azen SP, et al. Coronary artery calcium score combined with Framingham score for risk prediction in asymptomatic individuals. JAMA. 2004 Jan 14;291(2):210-5.

Grosse C. Globits S. Hergan K. Forty-slice spiral computed tomography of the coronary arteries: assessment of image quality and diagnostic accuracy in a non-selected patient population. Acta Radiologica. 2007;48(1): 36-44.

Haberl R, Becker A, Leber A, et al. Correlation of coronary calcification and angiographically documented stenoses in patients with suspected coronary artery disease: results of 1,764 patients J Am Coll Cardiol 2001;37:451-457.

Hamon M, Biondi-Zoccai GG, Malagutti P, et al. Diagnostic performance of multislice spiral computed tomography of coronary arteries as compared with conventional invasive coronary angiography: a meta-analysis. J Am Coll Cardiol.

2006 Nov 7;48(9):1896-910. Epub 2006 Sep 26.

Hausleiter J, Meyer T, Hadamitzky M, et al. Non-invasive coronary computed tomographic angiography for patients with suspected coronary artery disease: the Coronary Angiography by Computed Tomography with the Use of a Submillimeter resolution (CACTUS) trial. Eur Heart J. 2007 Dec;28(24):3034-41.

Hayes, Inc. Search and summary. 32 and 40 multislice cardiac CT. Lansdale, PA: Hayes, Inc. September 2008.

Hayes, Inc.. Hayes Directory. Multislice computed tomography for detection of coronary artery disease. Lansdale, PA:

Hayes, Inc. July 2007. Updated July 2008.

Hayes, Inc.. Hayes Directory. Electron beam computed tomography for coronary artery disease. Lansdale, PA: Hayes, Inc. June 2003. Updated May 2008.

Hendel RC, Patel MR, Kramer CM, et al. ACCF/ACR/SCCT/SCMR/ASNC/NASCI/SCAI/SIR 2006 appropriateness criteria for cardiac computed tomography and cardiac magnetic resonance imaging: a report of the American College of Cardiology Foundation Quality Strategic Directions Committee Appropriateness Criteria Working Group, American College of Radiology, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, American Society of Nuclear Cardiology, North American Society for Cardiac Imaging, Society for Cardiovascular Angiography and Interventions, and Society of Interventional Radiology. J Am Coll Cardiol. 2006 Oct 3;48(7):1475-97.

Jones CM, Athanasiou T, Dunne N, et al. Multi-detector computed tomography in coronary artery bypass graft assessment: a meta-analysis. Ann Thorac Surg. 2007 Jan;83(1):341-8.

Knez A, Becker A, Leber A, White C, Becker CR, Reiser MF, Steinbeck G, Boekstegers P. Relation of coronary calcium scores by electron beam tomography to obstructive disease in 2,115 symptomatic patients. Am J Cardiol. 2004; 93: 1150LaMonte MJ, FitzGerald SJ, Church TS, Barlow CE, Radford NB, Levine BD et al. Coronary artery calcium score and Cardiac Computed Tomography (CT), Coronary Artery Calcium Scoring and Cardiac CT Angiography - Commercial Medical Management Guideline coronary heart disease events in a large cohort of asymptomatic men and women. Am J Epidemiol. 2005 Sep 1;162(5):421-9.

Lim MC, Wong TW, Yaneza LO, et al. Non-invasive detection of significant coronary artery disease with multi-section computed tomography angiography in patients with suspected coronary artery disease. Clin Radiol. 2006 Feb;61(2):174Matchar DB, Mark DB, Patel MR, et al. Non-invasive imaging for coronary artery disease. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2006 Oct 3. Available at: http://www.cms.hhs.gov/determinationprocess/ downloads/id34TA.pdf. Accessed April 7, 2009.

McClelland RL, Chung H, Detrano R, et al. Distribution of coronary artery calcium by race, gender, and age: results from the Multi-Ethnic Study of Atherosclerosis (MESA). Circulation. 2006 Jan 3;113(1):30-7.

Miller JM, Rochitte CE, Dewey M, et al. Diagnostic performance of coronary angiography by 64-row CT. N Engl J Med.

2008 Nov 27;359(22):2324-36.

National Heart Lung and Blood Institute. Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Final Report. September 2002. Available at: http://www.nhlbi.nih.gov/guidelines/cholesterol/atp3full.pdf. Accessed April 7, 2009.

O'Malley PG, Feuerstein IM, Taylor AJ. Impact of electron beam tomography, with or without case management, on motivation, behavioral change, and cardiovascular risk profile: a randomized controlled trial. JAMA. 2003 May 7;289(17):2215-23.

O'Rourke R, Brundage BH, Froelicher VF, et al. American College of Cardiology/American Heart Association Expert Consensus Document on electron beam computed tomography for the diagnosis and prognosis of coronary artery disease.

J Am Coll Cardiol. 2000;36:326-40.

Pletcher MJ, Tice JA, Pignone M, Browner WS. Using the coronary artery calcium score to predict coronary heart disease events: A systematic review and meta-analysis. Arch Intern Med. 2004;164(12):1285-92.

Poon M, Rubin GD, Achenbach S, et al. Consensus update on the appropriate usage of cardiac computed tomographic angiography. J Invasive Cardiol. 2007 Nov;19(11):484-90.

Schmermund A, Mohlenkamp S, Berenbein S, et al. Population-based assessment of subclinical coronary atherosclerosis using electron-beam computed tomography. Atherosclerosis. 2006 Mar;185(1):177-82.

Schroeder S, Achenbach S, Bengel F, et al. Cardiac computed tomography: indications, applications, limitations, and training requirements: report of a Writing Group deployed by the Working Group Nuclear Cardiology and Cardiac CT of the European Society of Cardiology and the European Council of Nuclear Cardiology. Eur Heart J. 2008 Feb;29(4):531Schuijf JD, Bax JJ, Shaw LJ, de Roos A, Lamb HJ, van der Wall EE, Wijns W. Meta-analysis of comparative diagnostic performance of magnetic resonance imaging and multislice computed tomography for noninvasive coronary angiography.

Am Heart J. 2006; 151: 404-411.

Stein PD, Beemath A, Kayali F, Skaf E, Sanchez J, Olson RE. Multidetector computed tomography for the diagnosis of Cardiac Computed Tomography (CT), Coronary Artery Calcium Scoring and Cardiac CT Angiography - Commercial Medical Management Guideline coronary artery disease: a systematic review. Am J Med. 2006; 119: 203-216.

Sun Z, Jiang W. Diagnostic value of multislice computed tomography angiography in coronary artery disease: A metaanalysis. Eur J Radiol. 2006 Nov;60(2):279-86.

U.S. Preventive Services Task Force (USFSTF). Recommendation Statement. Screening for coronary heart disease.

February 2004. Available at: http://www.ahrq.gov/clinic/3rdUSpstf/chd/chdrs.htm. Accessed April 7, 2009.

van der Vleuten PA, Willems TP, GMJ, et al. Quantification of global left ventricular function: comparison of multidetector computed tomography and magnetic resonance imaging. a meta-analysis and review of the current literature. Acta Radiol. 2006 Dec;47(10):1049-57.

Vanhoenacker PK, Heijenbrok-Kal MH, Van Heste R, et al. Diagnostic performance of multidetector CT angiography for assessment of coronary artery disease: meta-analysis. Radiology. 2007 Aug;244(2):419-28.

Watkins MW, Hesse B, Green CE, et al. Detection of coronary artery stenosis using 40-channel computed tomography with multi-segment reconstruction. Am J Cardiol. 2007 Jan 15;99(2):175-81.

Weinreb JC, Larson PA, Woodard PK, et al. American College of Radiology clinical statement on noninvasive cardiac imaging. Radiology. 2005;235(3):723-727.

Wilson PWF, D'Agostino RB, Levy D, et al. Prediction of coronary heart disease using risk factor categories. Circulation 1998;97:1837-1847.

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Cardiac Computed Tomography (CT), Coronary Artery Calcium Scoring and Cardiac CT Angiography - Commercial Medical Management Guideline New policy. Medical policy "Multislice Sprial Computed Tomography for Detection and Evaluation of 11/17/2005 Coronary Artery Disease" (2004T0461A) retired.

Contact Information For questions regarding this policy, send an email to the Medical Technology Interpretation Service at medical_drug_interpretation@uhc.com with the word "Medical" in the subject line.

Coding The Current Procedural Terminology (CPT) codes and HCPCS codes listed in this policy are for reference purposes only.

Listing of a service code in this policy does not imply that the service described by this code is a covered or non-covered health service. Coverage is determined by the benefit document.

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