Coronary Angiography for Known or Suspected Coronary Artery Disease in Adults
Defines medical necessity criteria, preferred and non-preferred sites of service, age applicability (adults 19+), documentation requirements, and CPT/HCPCS coding related to diagnostic coronary angiography. This is Part 1 of 2 and covers policy criteria, site-of-service rules, indications (including angina, high-risk noninvasive findings, post-MI risk stratification, and other high-risk factors), documentation expectations, coding lists, and supporting background/guidelines.
Added medically necessary policy statement for high-risk CAD based on noninvasive findings of CCTA (interim review 08/01/23).
Multiple HCPCS coding updates adding numerous C75xx codes across 2023-2026.
Policy statements unchanged in most annual reviews; wording standardized from 'patient' to 'individual' (04/01/23).
Policy was deleted effective July 2, 2020 and replaced with InterQual criteria, then reinstated effective February 5, 2021.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.