Private Insurance Companies Announce New Coverage for Cardiac CTA
January 25, 2008
Private insurance companies in 15 states have introduced new coverage of cardiac CT angiography (CTA) or have extended policies that were already in place.
Among the changes:
Plans in Florida, Idaho, Oregon, Utah, Washington, Kansas, and Tennessee added coverage for cardiac CTA for assessing anomalous arteries when conventional angiography is equivocal and CTA would affect treatment.
Plans in Iowa and South Dakota added coverage for cardiac CTA using a 64-slice scanner to evaluate various indications for coronary artery disease.
Plans in Illinois, Oklahoma, and New Mexico added coverage for cardiac CTA using a 64-slice scanner as an adjunct to other testing for coronary artery disease, as well as for other indications.
Detailed summary of changes
Changes in private plan coverage of cardiac CTA affecting non-Medicare patients:
Blue Cross and Blue Shield of Florida; Regence BCBS (Idaho, Oregon, Utah, Washington State); Blue Cross and Blue Shield of Kansas; Empire Blue Cross and Blue Shield (conforming change to Wellpoint/Anthem policy); and Blue Cross and Blue Shield of Tennessee added coverage for the assessment of anomalous arteries when conventional angiography is equivocal and the results of the CTA will impact treatment.
Wellmark (Iowa, South Dakota) added coverage for CTA using a 64-slice scanner to evaluate coronary arteries for detection of CAD symptomatic evaluation of chest pain syndrome; detection of CAD symptomatic for evaluation of intracardiac structures; detection of CAD symptomatic for acute chest pain; detection of CAD with prior test results for evaluation of chest pain syndrome; structure and function morphology; structure and function evaluation of aortic and pulmonary disease.
Horizon Blue Cross and Blue Shield (NJ) revised criteria and added 64-slice scanner requirement and clinical competence requirements.
Health Care Services Corporation (Blue Cross and Blue Shield of Illinois, Oklahoma, New Mexico and Oklahoma) added coverage for CTA using 64-slice scanner as an adjunct to other testing for CAD, evaluation of cardiac structure, coronary arteries or cardiac mass.
Excellus (upstate NY) added coverage for CTA using a 64-slice scanner.
Blue Cross and Blue Shield of North Carolina added coverage in accordance with AIM guidelines
Changes in Medicare carrier Local Coverage Determinations (LCDs) for cardiac CTA affecting Medicare patients:
Blue Cross and Blue Shield of Florida covers CTA for suspected anomalies of coronary arteries when conventional angiography is equivocal and results will impact treatment.
Administar (Indiana, Kentucky) added a requirement for 64-slice scanner for evaluation of functional status effective 12/1/09 and requirements for clinical competence as defined by ACC/AHA and ACR criteria.
Empire HealthChoice (NY, NJ) delayed 64-slice scanner requirement for functional status to 12/1/09 (16-slice scanner requirement for all other indications).
HealthNow and GHI (NY) also now require 64-slice scanner for functional status evaluations (16-slice scanner for other indications).
