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Electron Beam Computed Tomography (EBCT) for Screening Evaluations
MA09.011b

Policy

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


There is no Medicare coverage determination addressing this service; therefore, the Company policy is applicable.

BENEFIT APPLICATION

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


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


Arnett DK, Blumenthal RS, Albert MA, et al. 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. Sep 10 2019; 140(11): e596-e646.

Blaha MJ, Cainzos-Achirica M, Greenland P, et al. Role of coronary artery calcium score of zero and other negative risk markers for cardiovascular disease: the Multi-Ethnic Study of Atherosclerosis (MESA). Circulation. 2016;133(9):849-858. ​


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, Young R, Burke G et al. Ten-year association of coronary artery calcium with atherosclerotic cardiovascular disease (ASCVD) events: the multi-ethnic study of atherosclerosis (MESA). Eur Heart J. 2018;39(25). 


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. 

Chaikriangkrai K, Palamaner Subash Shantha G, Jhun HY, et al. Prognostic Value of Coronary Artery Calcium Score in Acute Chest Pain Patients Without Known Coronary Artery Disease: Systematic Review and Meta-analysis. Ann Emerg Med. Dec 2016; 68(6): 659-670.

Chaikriangkrai K, Velankar P, Schutt R, et al. Additive prognostic value of coronary artery calcium score over coronary computed tomographic angiography stenosis assessment in symptomatic patients without known coronary artery disease. Am J Cardiol. Mar 15 2015; 115(6): 738-44. ​

Chang SM, Nabi F, Xu J, et al. Value of CACS compared with ETT and myocardial perfusion imaging for predicting long-term cardiac outcome in asymptomatic and symptomatic patients at low risk for coronary disease: clinical implications in a multimodality imaging world. JACC Cardiovasc Imaging. Feb 2015; 8(2): 134-44. 

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.

Erbel R, Mohlenkamp S, Moebus S, et al. Coronary risk stratification, discrimination, and reclassification improvement based on quantification of subclinical coronary atherosclerosis: the Heinz Nixdorf Recall study. J Am Coll Cardiol. Oct 19 2010; 56(17): 1397-406.

Ferencik M, Pencina KM, Liu T, et al. Coronary Artery Calcium Distribution Is an Independent Predictor of Incident Major Coronary Heart Disease Events: Results From the Framingham Heart Study. Circ Cardiovasc Imaging. Oct 2017; 10(10).

Gepner AD, Young R, Delaney JA, et al. Comparison of carotid plaque score and coronary artery calcium score for predicting cardiovascular disease events: the multi-ethnic study of atherosclerosis. J Am Heart Assoc.  2017;6(2).


Gibson AO, Blaha MJ, Arnan MK, et al. Coronary artery calcium and incident cerebrovascular events in an asymptomatic cohort. The MESA Study. JACC Cardiovasc Imaging. Nov 2014; 7(11): 1108-15.​​

Gottlieb I, Miller JM, Arbab-Zadeh A, et al. The absence of coronary calcification does not exclude obstructive coronary artery disease or the need for revascularization in patients referred for conventional coronary angiography. J Am Coll Cardiol. Feb 16 2010; 55(7): 627-34. 

Grundy SM, Stone NJ, Bailey AL et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2018;139(25)​​.

Gupta A, Lau E, Varshney R, et al. The Identification of Calcified Coronary Plaque Is Associated With Initiation and Continuation of Pharmacological and Lifestyle Preventive Therapies: A Systematic Review and Meta-Analysis. JACC Cardiovasc Imaging. Aug 2017; 10(8): 833-842.

Han D, Hartaigh BO, Gransar H, et al. Incremental prognostic value of coronary computed tomography angiography over coronary calcium scoring for major adverse cardiac events in elderly asymptomatic individuals. Eur Heart J Cardiovasc Imaging. 2018;19(6):675-683. 

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.

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.

Jacobs PC, Gondrie MJ, van der Graaf Y, et al. Coronary artery calcium can predict all-cause mortality and cardiovascular events on low-dose CT screening for lung cancer. AJR Am J Roentgenol. Mar 2012; 198(3): 505-11.


Jacobs PC, Gondrie MJ, Mali WP, et al. Unrequested information from routine diagnostic chest CT predicts future cardiovascular events. Eur Radiol. Aug 2011; 21(8): 1577-85. 


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.

Kelkar AA, Schultz WM, Khosa F, et al. Long-Term Prognosis After Coronary Artery Calcium Scoring Among Low-Intermediate Risk Women and Men. Circ Cardiovasc Imaging. Apr 2016; 9(4): e003742.

Lehmann N, Erbel R, Mahabadi AA, et al. Value of Progression of Coronary Artery Calcification for Risk Prediction of Coronary and Cardiovascular Events: Result of the HNR Study (Heinz Nixdorf Recall). Circulation. Feb 13 2018; 137(7): 665-679.

Lin JS. Nontraditional risk factors in cardiovascular disease risk assessment: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA. 2018;320(3):281-297.

Lloyd-Jones DM, Braun LT, Ndumele CE et al. Use of Risk Assessment Tools to Guide Decision-Making in the Primary Prevention of Atherosclerotic Cardiovascular Disease: A Special Report From the American Heart Association and American College of Cardiology. Circulation. 2019;139(25).​

Lo-Kioeng-Shioe MS, Rijlaarsdam-Hermsen D, van Domburg RT, et al. Prognostic value of coronary artery calcium score in symptomatic individuals: A meta-analysis of 34,000 subjects. Int J Cardiol. Jan 15 2020; 299: 56-62. 

Lubbers M, Dedic A, Coenen A, et al. Calcium imaging and selective computed tomography angiography in comparison to functional testing for suspected coronary artery disease: the multicentre, randomized CRESCENT trial. Eur Heart J. Apr 14 2016; 37(15): 1232-43.

Mamudu HM, Paul TK, Veeranki SP, et al. The effects of coronary artery calcium screening on behavioral modification, risk perception, and medication adherence among asymptomatic adults: a systematic review. Atherosclerosis. Oct 2014; 236(2): 338-50.​

Nakanishi R, Li D, Blaha MJ, et al. All-cause mortality by age and gender based on coronary artery calcium scores. Eur Heart J Cardiovasc Imaging. 2016;17(11):1305-1314. 

National Institute for Health and Care Excellence. Chest pain of recent onset: assessment and diagnosis [CG95]. 2016; https://www.nice.org.uk/guidance/cg95/chapter/Recommendations. 

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. 

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.

Pursnani A, Chou ET, Zakroysky P, et al. Use of coronary artery calcium scanning beyond coronary computed tomographic angiography in the emergency department evaluation for acute chest pain: the ROMICAT II trial. Circ Cardiovasc Imaging. Mar 2015; 8(3).

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.

Sarwar A, Shaw LJ, Shapiro MD, et al. Diagnostic and prognostic value of absence of coronary artery calcification. JACC Cardiovasc Imaging. 2009;2(6):675-688. 

Silverman MG, Blaha MJ, Krumholz HM, et al. Impact of coronary artery calcium on coronary heart disease events in individuals at the extremes of traditional risk factor burden: the Multi-Ethnic Study of Atherosclerosis. Eur Heart J. Sep 01 2014; 35(33): 2232-41. 

ten 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.

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 August 19, 2020.

US Preventive Services Task Force. Cardiovascular Disease: Risk Assessment With Nontraditional Risk Factors. 2018. Available at: https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/cardiovascular-disease-screening-using-nontraditional-risk-assessment?ds=1&s=risk assessment. Accessed 09/03/2020.

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.

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):601-607.


Won KB, Chang HJ, Niinuma H, et al. Evaluation of the predictive value of coronary artery calcium score for obstructive coronary artery disease in asymptomatic Korean patients with type 2 diabetes mellitus. Coron Artery Dis. Mar 2015; 26(2): 150-6. ​


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.​

Yoon YE, Chang SA, Choi SI, et al. The absence of coronary artery calcification does not rule out the presence of significant coronary artery disease in Asian patients with acute chest pain. Int J Cardiovasc Imaging. Feb 2012; 28(2): 389-98.


Coding

CPT Procedure Code Number(s)
N/A

ICD - 10 Procedure Code Number(s)
N/A

ICD - 10 Diagnosis Code Number(s)

N/A


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

8/2/2021
8/2/2021
8/24/2022
MA09.011
Medical Policy Bulletin
Medicare Advantage
No