CT Heart Scan   a resource for patients and physicians

       Cost and Insurance Coverage


 

 Cash charges:
        CT coronary angiography          $1250
        CT calcium scoring                     $ 345

Insurance coverage for CT heart scans is highly variable. In November of 2006 Medicare of Northern California issued a local coverage determination (LCD) using T codes which is likely to be followed by most other payers, probably in 2008. The major indications for coverage by Medicare are as follows:

  • Cardiac evaluation of a patient with signs or symptoms  of coronary artery disease (chest pain, angina equivalent, newly abnormal ECG). The CT scan may precede stress testing or may be used to clarifiy a non-diagnostic or equivocal stress test 
  • Facilitation of the management of a symptomatic patient  with known coronary artery disease
  • Cardiac evaluation of an asymptomatic or symptomatic patient at high cardiovascular risk (LV dysfunction of unknown etiology or diabetics with multiple risk factors)
  • Assessment of coronary anatomy prior to non-coronary cardiac surgery (e.g. valve replacement)
  • Assessment of coronary  anatomy after technically inadequate or non-diagnostic  coronary angiogram (e.g. non-visualized grafts or anomalous native vessels)
  • Anatomic evaluation of patients undergoing electrophysiology procedures
  • Assessment of suspected  congenital coronary artery anomalies
  • Assessment of suspected aortic dissection or injury
  • Coronary artery calcium scoring for lipid management of asymptomatic patients with at least intermediate risk factors for CAD
Despite coverage by Medicare, commercial insurers have still labeled CT heart scans as "experimental" although some will pay on appeal when the advantage of the test has been obvious. For now, one should assume that a patient with commercial insurance will have to pay cash. Our cash charges of $1250 for CT coronary angiography and $345 for CT calcium scoring are among the lowest in the Bay Area, far below the charges of academic hospitals.

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