Cleerly costs & coverage


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CIGNA

Coronary CTA plaque quantification (CPT® 0623T, 0624T, 0625T, 0626T) Coronary CT plaque quantification or coronary plaque analysis using data from CCTA is medically necessary when all of the following conditions exist:

  • The individual has acute or stable chest pain with no known coronary artery disease (CAD)
  • Results from the current completed and interpreted CCTA indicate any of the following risk categories:
    • Intermediate risk
    • CAD-RADS 1
    • CAD-RADS 2
    • CAD-RADS 3
  • Cardiac evaluation is negative or inconclusive for acute coronary syndrome

United Healthcare

Coronary CTA plaque quantification (CPT® 0623T, 0624T, 0625T, 0626T) Coronary CT plaque quantification or coronary plaque analysis using data from CCTA is medically necessary when all of the following conditions exist:

  • The individual has acute or stable chest pain with no known coronary artery disease (CAD)
  • Results from the current completed and interpreted CCTA indicate any of the following risk categories:
    • Intermediate risk
    • CAD-RADS 1
    • CAD-RADS 2
    • CAD-RADS 3
  • Cardiac evaluation is negative or inconclusive for acute coronary syndrome

 

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