Notification



Notification Issue Date:



Medical Policy Bulletin


Title:Electron Beam Computed Tomography (EBCT) for Screening Evaluations

Policy #:09.00.02e

This policy is applicable to the Company’s commercial products only. Policies that are applicable to the Company’s Medicare Advantage products are accessible via a separate Medicare Advantage policy database.


The Company makes decisions on coverage based on Policy Bulletins, benefit plan documents, and the member’s medical history and condition. Benefits may vary based on contract, and individual member benefits must be verified. The Company determines medical necessity only if the benefit exists and no contract exclusions are applicable.

When services can be administered in various settings, the Company reserves the right to reimburse only those services that are furnished in the most appropriate and cost-effective setting that is appropriate to the member’s medical needs and condition. This decision is based on the member’s current medical condition and any required monitoring or additional services that may coincide with the delivery of this service.

This Medical Policy Bulletin document describes the status of medical technology at the time the document was developed. Since that time, new technology may have emerged or new medical literature may have been published. This Medical Policy Bulletin will be reviewed regularly and be updated as scientific and medical literature becomes available. For more information on how Medical Policy Bulletins are developed, go to the About This Site section of this Medical Policy Web site.



Policy

Coverage is subject to the terms, conditions, and limitations of the member's contract.

Electron beam computed tomography (EBCT) performed as a screening tool to quantify the amount of calcium in the coronary arteries or to predict the risk for development of coronary artery disease is considered not medically necessary and, therefore, not covered because the available published peer-reviewed literature does not support its use in the diagnosis or treatment of illness or injury.
Guidelines

BENEFIT APPLICATION

Subject to the terms and conditions of the applicable benefit contract, electron beam computed tomography (EBCT) is not eligible for payment under the medical benefits of the Company’s products because the service is considered not medically necessary and, therefore, not covered.

BILLING GUIDELINES

When billing EBCT, providers should report the specific Healthcare Common Procedural Coding System (HCPCS) procedure code (S8092) that describes this service.

Description

Electron beam computed tomography (EBCT), which is also known as ultrafast CT, cine-computerized x-ray tomography, and high-speed computed x-ray tomography, uses an electron beam gun to permit very rapid scanning that creates images by rotating a standard x-ray tube around an individual. The data is gathered into a continuous spiral or helix rather than individual slices. EBCT's speed of image acquisition allows for unique imaging of the heart.

EBCT software permits quantification of calcium area and density, which are translated into calcium scores. Calcium scores have been investigated as a technique for detecting coronary artery calcification. For symptomatic individuals, calcium scores are a diagnostic technique to help determine the necessity of coronary angiography. For asymptomatic individuals, calcium scores are viewed as a screening tool for coronary artery disease. However, current evidence in the peer-reviewed literature does not establish that EBCT results in improved health outcomes. High-quality evidence is lacking comparing the use of coronary artery calcium screening to other methods of enhanced risk prediction. Additionally, Guidelines published jointly by the American College of Cardiology and the American Heart Association indicate that for asymptomatic individuals, studies have not shown that the detection of coronary artery calcification improves upon the prognostic information from risk factor models such as the Framingham Heart Study or the National Cholesterol Education Program-III.
References


Arad Y, Goodman KJ, Roth M, et al. Coronary calcification, coronary disease risk factors, C-reactive protein, and atherosclerotic cardiovascular disease events: the St. Francis Heart Study. J Am Coll Cardiol. 2005; 46(1):158-165.

Bischoff B, Kantert C, Meyer T et al. Cardiovascular risk assessment based on the quantification of coronary calcium in contrast-enhanced coronary computed tomography angiography. Eur Heart J Cardiovasc Imaging. 2012; 13(6):468-75.

Blue Cross and Blue Shield Association Technology Evaluation Center (TEC). Diagnosis and screening for coronary artery disease with electron beam computed tomography. TEC Assessments 1998; Volume 13, Tab 27.

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; 114(16):1761-1791.

Budoff MJ, Mohlenkamp S, McClelland R et al. A comparison of outcomes with coronary artery calcium scanning in unselected populations: the Multi-Ethnic Study of Atherosclerosis (MESA) and Heinz Nixdorf RECALL study (HNR). J Cardiovasc Comput Tomogr. 2013; 7(3):182-91.

Budoff MJ, Shaw LJ, Liu ST, et al. Long-term prognosis associated with coronary calcification: observations from a registry of 25,253 patients. J Am Coll Cardiol. 2007; 49(18):1860-1870.

Dharampal AS, Rossi A, Dedic A et al. Restriction of the referral of patients with stable angina for CT coronary angiography by clinical evaluation and calcium score: impact on clinical decision making. Eur Radiol. 2013; 23(10):2676-86.

Elias-Smale SE, Wieberdink RG, Odink AE et al. Burden of atherosclerosis improves the prediction of coronary heart disease but not cerebrovascular events: the Rotterdam Study. Eur Heart J. 2011; 32(16-Jan):2050-8.

Elkeles RS, Godsland IF, Feher MD et al. Coronary calcium measurement improves prediction of cardiovascular events in asymptomatic patients with type 2 diabetes: the PREDICT study. Eur Heart J. 2008; 29(18):2244-51.

Ferket BS, Genders TS, Colkesen EB et al. Systematic review of guidelines on imaging of asymptomatic coronary artery disease. J Am Coll Cardiol. 2011; 57(15):1591-600.

Fihn SD, Gardin JM, Abrams J et al. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol. 2012; 60(24):e44-e164.

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; 49(3):378-402.

Greenland P, Alpert JS, Beller GA, et al. 2010 ACCF/AHA guideline for assessment of cardiovascular risk in asymptomatic adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2010; 56(25):e50-103.

Greenland P, LaBree L, Azen SP, et al. Coronary artery calcium score combined with Framingham score for risk prediction in asymptomatic individuals. JAMA. 2004; 291(2):210-215.

Helfand M, Buckley DI, Freeman M, et al. Emerging risk factors for coronary heart disease: a summary of systematic reviews conducted for the U.S. Preventive Services Task Force. Ann Intern Med 2009; 151(7):496-507.

Hou ZH, Lu B, Gao Y et al. Prognostic value of coronary CT angiography and calcium score for major adverse cardiac events in outpatients. JACC Cardiovasc Imaging. 2012; 5(10):990-9.

Hulten E, Bittencourt MS, Ghoshhajra B et al. Incremental prognostic value of coronary artery calcium score versus CT angiography among symptomatic patients without known coronary artery disease. Atherosclerosis. 2014; 233(1):190-5.

Johnson JE, Gulanick M, Penckofer S et al. Does Knowledge of Coronary Artery Calcium Affect Cardiovascular Risk Perception, Likelihood of Taking Action, and Health-Promoting Behavior Change? J Cardiovasc Nurs. 2015; 30(1):15-25.

Kate GJ, Caliskan K, Dedic A et al. Computed tomography coronary imaging as a gatekeeper for invasive coronary angiography in patients with newly diagnosed heart failure of unknown aetiology. Eur J Heart Fail. 2013; 15(9):1028-34.

Lakoski SG, Greenland P, Wong ND, et al. Coronary artery calcium scores and risk for cardiovascular events in women classified as "low risk" based on Framingham risk score: the multi-ethnic study of atherosclerosis (MESA). Arch Intern Med. 2007; 167(22):2437-2442.

LaMonte MJ, FitzGerald SJ, Church TS, et al. Coronary artery calcium score and coronary heart disease events in a large cohort of asymptomatic men and women. Am J Epidemiol. 2005; 162(5):421-429.

Laudon DA, Behrenbeck TR, Wood CM, et al. Computed tomographic coronary artery calcium assessment for evaluating chest pain in the emergency department: long-term outcome of a prospective blind study. Mayo Clin Proc. 2010; 85(4):314-22.

Martin SS, Blaha MJ, Blankstein R et al. Dyslipidemia, coronary artery calcium, and incident atherosclerotic cardiovascular disease: implications for statin therapy from the multi-ethnic study of atherosclerosis. Circulation. 2014; 129(1):77-86.

Meyer M, Henzler T, Fink C et al. Impact of coronary calcium score on the prevalence of coronary artery stenosis on dual source CT coronary angiography in caucasian patients with an intermediate risk. Acad Radiol. 2012; 19(11):1316-23.

Mozaffarian D. Electron-beam computed tomography for coronary calcium: a useful test to screen for coronary heart disease? JAMA. 2005; 294(22):2897-2901.

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; 289(17):2215-23.

O'Rourke RA, 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(1):326-340.

Petretta M, Daniele S, Acampa W et al. Prognostic value of coronary artery calcium score and coronary CT angiography in patients with intermediate risk of coronary artery disease. Int J Cardiovasc Imaging. 2012; 28(6):1547-56.

Polonsky TS, McClelland RL, Jorgensen NW et al. Coronary artery calcium score and risk classification for coronary heart disease prediction. JAMA. 2010; 303(16):1610-6.

Rozanski A, Gransar H, Shaw LJ, et al. Impact of coronary artery calcium scanning on coronary risk factors and downstream testing. J Am Coll Cardiol. 2011; 57:1622-1632.

Taylor AJ, Bindeman J, Feuerstein I, et al. Coronary calcium independently predicts incident premature coronary heart disease over measured cardiovascular risk factors: mean three-year outcomes in the Prospective Army Coronary Calcium (PACC) project. J Am Coll Cardiol. 2005; 46(5):807-814.

Taylor AJ, Cerqueira M, Hodgson JM et al. ACCF/SCCT/ACR/AHA/ASE/ASNC/NASCI/ SCAI/SCMR 2010 appropriate use criteria for cardiac computed tomography. A report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, the Society of Cardiovascular Computed Tomography, the American College of Radiology, the American Heart Association, the American Society of Echocardiography, the American Society of Nuclear Cardiology, the North American Society for Cardiovascular Imaging, the Society for Cardiovascular Angiography and Interventions, and the Society for Cardiovascular Magnetic Resonance. J Am Coll Cardiol. 2010; 56(22):1864-94.

US Food and Drug Administration (FDA). Center for Devices and Radiologic Health. Ultrafast® Computed Tomographic (CT) Scanner Systems. 510(k) summary. [FDA Web site]. 03/17/2000. Available at: http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfPMN/pmn.cfm?ID=K000359. Accessed July 6, 2018.

US Preventive Services Task Force. Using nontraditional risk factors in coronary heart disease risk assessment: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med.2009; 151(7):474-82.

Whelton SP, Nasir K, Blaha MJ et al. Coronary artery calcium and primary prevention risk assessment: what is the evidence? An updated meta-analysis on patient and physician behavior. Circ Cardiovasc Qual Outcomes. 2012; 5(4):601-7.

Yerramasu A, Lahiri A, Venuraju S et al. Diagnostic role of coronary calcium scoring in the rapid access chest pain clinic: prospective evaluation of NICE guidance. Eur Heart J Cardiovasc Imaging. 2014; 15(8):886-92.





Coding

Inclusion of a code in this table does not imply reimbursement. Eligibility, benefits, limitations, exclusions, precertification/referral requirements, provider contracts, and Company policies apply.

The codes listed below are updated on a regular basis, in accordance with nationally accepted coding guidelines. Therefore, this policy applies to any and all future applicable coding changes, revisions, or updates.

In order to ensure optimal reimbursement, all health care services, devices, and pharmaceuticals should be reported using the billing codes and modifiers that most accurately represent the services rendered, unless otherwise directed by the Company.

The Coding Table lists any CPT, ICD-9, ICD-10, and HCPCS billing codes related only to the specific policy in which they appear.

CPT Procedure Code Number(s)

N/A


Professional and outpatient claims with a date of service on or before September 30, 2015, must be billed using ICD-9 codes. Professional and outpatient claims with a date of service on or after October 1, 2015, must be billed using ICD-10 codes.

Facility/Institutional inpatient claims with a date of discharge on or before September 30, 2015, must be billed with ICD-9 codes. Facility/Institutional inpatient claims with a date of discharge on or after October 1, 2015, must be billed with ICD-10 codes.


ICD - 10 Procedure Code Number(s)

N/A


Professional and outpatient claims with a date of service on or before September 30, 2015, must be billed using ICD-9 codes. Professional and outpatient claims with a date of service on or after October 1, 2015, must be billed using ICD-10 codes.

Facility/Institutional inpatient claims with a date of discharge on or before September 30, 2015, must be billed with ICD-9 codes. Facility/Institutional inpatient claims with a date of discharge on or after October 1, 2015, must be billed with ICD-10 codes.


ICD -10 Diagnosis Code Number(s)

This service is experimental for all diagnoses.


HCPCS Level II Code Number(s)

S8092 Electron beam computed tomography (also known as Ultrafast CT, Cine CT)


Revenue Code Number(s)

N/A

Coding and Billing Requirements



Policy History

Revisions 09.00.02e
08/15/2018This policy has been reviewed and reissued to communicate the Company’s continuing position on Electron Beam Computed Tomography (EBCT) for Screening Evaluations.
11/08/2017The policy has been reviewed and reissued to communicate the Company’s continuing position on Electron Beam Computed Tomography (EBCT) for Screening Evaluations.

Effective 10/05/2017 this policy has been updated to the new policy template format.
Version Effective Date: 03/15/2015
Version Issued Date: 03/11/2015
Version Reissued Date: 08/15/2018

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