Cardiac Computed Tomography (CT)
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This policy defines when Cardiac CT for evaluation of cardiac structure and morphology is considered medically necessary for Blue Cross and Blue Shield of Kansas members, with primary focus on congenital heart disease, preprocedural planning, and specific syndromic indications.
No material clinical or coverage changes in this revision.
Coverage Criteria
Medically Necessary Indications
Cardiac CT for evaluating cardiac structure and morphology may be medically necessary when ANY of the following are present:
The coding section is provided for informational purposes only. Inclusion or exclusion of a procedure, diagnosis, or device code(s) in this policy does not constitute or imply member coverage or provider reimbursement. Coverage for an individual service is determined by the member's contract benefits in effect at the time of service; consult the member’s contract and BCBSKS Customer Service or a predetermination request when coverage is uncertain.
Coding
| 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 and evaluation of venous structures, if performed) |
| A18.84 | Tuberculosis of heart |
| I01.1 | Acute rheumatic endocarditis |
| I05.0 | Rheumatic mitral stenosis |
| I05.1 | Rheumatic mitral insufficiency |
| I05.2 | Rheumatic mitral stenosis with insufficiency |
| I05.8 | Other rheumatic mitral valve diseases |
| I05.9 | Rheumatic mitral valve disease, unspecified |
| I06.0 | Rheumatic aortic stenosis |
| I06.1 | Rheumatic aortic insufficiency |
| I06.2 | Rheumatic aortic stenosis with insufficiency |
Provider Actions & Considerations
Contact BCBSKS / Predetermination
Contact Blue Cross and Blue Shield of Kansas (BCBSKS) Customer Service or submit a predetermination request if there are questions about coverage for this service. Policies may not reflect contract or state/federal mandates; verify benefits with BCBSKS Customer Service prior to performing services.
- Contact BCBSKS Customer Service for benefit verification prior to service.
- Submit a predetermination request when coverage is uncertain.
- Member contract, state and federal mandates govern coverage — inclusion of codes in this policy does not guarantee coverage.
Verify Member Benefits
Verify member benefits with Blue Cross and Blue Shield of Kansas Customer Service prior to scheduling or providing services to confirm eligibility, coverage limits, and applicable exclusions.
- Confirm member-specific coverage, benefit limits, and any applicable preauthorization requirements.
Coverage Determined by Member Contract
Inclusion of codes, procedures, diagnoses, or devices in this policy is for informational purposes only and does not imply coverage or reimbursement. Coverage is determined by the member's contract and any applicable state or federal mandates, which take precedence over this Medical Policy.
- Do not assume coverage solely because a code appears in this policy.
- Review the member's contract and any mandate language before billing.
Background
Cardiac Computed Tomography (CT) is used for the morphologic evaluation of the heart and related structures, including the cardiac chambers, valves, ventricular myocardium, coronary arteries and veins, aortic root, central pulmonary arteries and veins, and the pericardium. This policy focuses on use of Cardiac CT primarily in structural and congenital heart disease contexts and for preprocedural planning to guide interventions such as pulmonary vein isolation, coronary venous lead placement, and surgical repair of complex congenital lesions.
Definitions
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