Fractional Flow Reserve from Computed Tomography (FFRct)
This policy governs prior authorization, coverage criteria, and procedure limitations for noninvasive CT-derived fractional flow reserve (Heartflow FFRct) for stable symptomatic members with coronary artery disease in the Arkansas PASSE program.
No material clinical or coverage changes in this revision.
Coverage Criteria for FFRct
Coverage for stable symptomatic CAD
Covered when ALL of the following are met
Prior authorization and required documentation (including a prescription) must be submitted.
The following clinical presentations are explicitly excluded from coverage for Heartflow FFRct: recent prior myocardial infarction within 30 days and any suspicion of acute coronary syndrome where acute myocardial infarction or unstable angina have not been ruled out.
Additional exclusions include patients with complex congenital heart disease, those with a Body Mass Index >35, individuals with a history of prior coronary artery bypass graft (CABG) surgery, and patients who require emergent procedures or have evidence of ongoing or active clinical instability (for example: acute chest pain (sudden onset), cardiogenic shock, systolic blood pressure <90 mmHg, severe congestive heart failure NYHA III or IV, or acute pulmonary edema).
Coding and Measured Limits
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