Blue Cross Blue Shield of Minnesota Medical Policy


Medical Policy:
Computed Tomography (CT) to Detect Coronary Artery Calcification
Effective Date:
January 31, 2021
Issued Date:
January 31, 2021
Last Revision Date:
September 2020
Annual Review:
September 2020

This policy version was replaced on September 1, 2021. To find the newest version, go to, read and accept the Blue Cross Medical Policy Statement, then select “Blue Cross and Blue Shield of Minnesota Medical Policies.” This will bring up the Medical Policy search screen. Enter the policy number without the version number (last 3 digits).

Computed tomography (CT) using either spiral (helical) CT, electron beam CT (EBCT), or multi-detector CT (MDCT) can be used as a method for detecting coronary artery calcification. The CT scan allows automated quantification of the total size and density of the calcium deposits, which is reported as a calcium score. The coronary artery calcium score is used as a predictor of future risk of coronary artery disease and in the diagnosis of coronary artery disease in symptomatic patients.

Spiral CT, EBCT, and MDCT have faster scan times than conventional CT. Spiral CT is performed as the patient is transported continuously through the scanner and the scan device rotates around the patient in a corkscrew-like path. Modifying the spiral scanning technique by gating image acquisition to the electrocardiogram allows only those frames acquired during diastole to be utilized for analysis of coronary calcium. This has enabled the use of more readily available spiral scanners for the determination of a calcium score. MDCT uses multiple rows of detectors that spiral around the patient simultaneously during a rapid volumetric image acquisition. The current generation of MDCT scanners generally has at least 64 detector rows.

EBCT, also known as ultrafast CT, bounces a single, focused beam of electrons off a series of tungsten targets arrayed around the patient to acquire serial transaxial images of the heart and coronary arteries. Three-dimensional reconstructions of the coronary vasculature can be created. EBCT and MDCT were initially the primary fast CT methods for measurement of coronary artery calcification. More recently, CT angiography has been used to assess coronary calcium.

This policy is designed to address medical guidelines that are appropriate for the majority of individuals with a particular disease, illness, or condition. Each person's unique clinical circumstances may warrant individual consideration, based on review of applicable medical records.

Policy Position Coverage is subject to the specific terms of the member's benefit plan.

For applicable clinical criteria, see the following eviCore clinical guideline:

75571 S8092

Denial Statements

No additional statements.


Blue Cross and Blue Shield of Minnesota medical policies apply generally to all Blue Cross and Blue Plus plans and products. Benefit plans vary in coverage and some plans may not provide coverage for certain services addressed in the medical policies. When determining coverage, reference the member’s specific benefit plan, including exclusions and limitations.

Medicaid products may provide different coverage for certain services, which may be addressed in different policies. For Minnesota Health Care Program (MHCP) policies, please consult the MHCP Provider Manual website.

Medicare products may provide different coverage for certain services, which may be addressed in different policies. For Medicare National Coverage Determinations (NCD), Local Coverage Determinations (LCD), and/or Local Coverage Articles, please consult CMS, National Government Services, or CGS websites. 

Note that services with specific coverage criteria may be reviewed retrospectively to determine if criteria are being met. Retrospective denial of claims may result if criteria are not met.

Blue Cross and Blue Shield of Minnesota reserves the right to revise, update and/or add to its medical policies at any time without notice. Codes listed on this policy are included for informational purposes only and are subject to change without notice. Inclusion or exclusion of a code does not constitute or imply member coverage or provider reimbursement. 

These guidelines are the proprietary information of Blue Cross and Blue Shield of Minnesota. Any sale, copying or dissemination of the medical policies is prohibited; however, limited copying of medical policies is permitted for individual use.


CPT® codes copyright American Medical Association® 2022. All rights reserved.

CDT codes copyright American Dental Association® 2022. All rights reserved.