Effective April 1, 2020, we will reimburse for Coronary CT Angiograms when ordered to evaluate stable chest pain in members with low and intermediate risk for coronary artery disease (CAD) as first-line testing (CCTA-First). Computed tomographic angiography (CTA) is expected to replace the need for other functional stress testing in this population.
The following are considered functional stress tests:
The following CPT® codes will be reimbursed for suspected CAD:
How to Request Notification/Prior Authorization
You can complete the notification/prior authorization process:
After we receive your request and required clinical records, we’ll review the request and contact both the requesting care provider and member by mail and phone with our coverage decision within 15 calendar days from the date of submission or sooner based on regulations. If coverage is denied, details on how to appeal will be provided in the letter.
CTA will not be implemented for providers practicing in Rhode Island until reviewed and approved by the Rhode Island Office of Health Insurance Commissioner (OHIC).
Questions? Call Provider Services at the number on the back of the member’s ID card.