Where this LCD applies
Each contract number is a jurisdiction on the remittance; the policy binds claims processed under these contracts and no others.
Billing and coding: diagnoses and procedure codes
Since 2019 the codes live in the companion article rather than the LCD. Billing and Coding A59769 (Billing and Coding: Artificial Intelligence Enabled CT Based Quantitative Coronary Topography (AI-QCT)/Coronary Plaque Analysis (AI-CPA)) carries the diagnosis and procedure lists the contractor loads as the claims edit. CPT codes are shown as bare numbers because the descriptors are licensed by the AMA; HCPCS Level II descriptors are public and shown.
A59769: Billing and Coding: Artificial Intelligence Enabled CT Based Quantitative Coronary Topography (AI-QCT)/Coronary Plaque Analysis (AI-CPA) (Billing and Coding, effective 2026-01-01)
- Covered ICD-10-CM codes
- 1
- 1 group
- Non-covered ICD-10-CM codes
- 0
- Procedure codes listed
- 1
- Full article
- cms.gov record
| ICD-10-CM | Description (FY2027) |
|---|---|
| R93.1 | — |
Procedure codes: 75577.
Coverage indications, limitations and medical necessity
AI-QCT/AI-CPA using CCTA* is considered reasonable and medically necessary as a diagnostic study when:
• The patient has acute or stable chest pain with no known CAD 1 and is eligible for CCTA*, AND
• CCTA classifies patient as:
• Intermediate risk ** OR
• CAD-RADS 1, CAD-RADS 2 or CAD-RADS 3 ***, category on CCTA 1,2 AND
• Cardiac evaluation is negative or inconclusive for acute coronary syndrome (ACS) 1
AI-QCT/AI-CPA should not be performed until after the base study (CCTA) has been completed and interpreted. Software to perform AI-QCT/AI-CPA must be FDA cleared or approved.
**Intermediate and high-risk as defined in the 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain 1
*** CAD-RADS 1-CAD-RADS 3 category as defined by CAD-RADS™ 2.0–2022 Coronary Artery Disease Reporting and Data System (CAD-RADS) : an Expert Consensus document of the Society of Cardiovascular Computed Tomography (SCCT), the American College of Cardiology (ACC), the American College of Radiology (ACR), and the North America Society of Cardiovascular Imaging (NASCI). 2,3
Limitations
Software to perform AI-CPA must be FDA cleared or approved.
AI-QCT/AI-CPA is NOT considered reasonable or necessary in the following clinical circumstance (non-covered):
• Screening, i.e., in the absence of signs, symptoms, or disease.
• When there is a contraindication to CCTA.*
• In conjunction with invasive coronary catheterization.
• In the presence of normal CCTA results (CAD RADS=0 or no plaque disease).
• In the presence of high grade stenosis (>70%) or CAD RADS-4 and RADS-5.
• Within 30 days of a myocardial infarction (MI).
• In the presence of unstable coronary symptoms.
• For disease surveillance.
Definitions
Artificial Intelligence Enabled CT Based Quantitative Coronary Topography ( AI -QCT )/ Coronary Plaque Analysis (AI-CPA)- artificial intelligence application to imaging obtained through coronary CT scans to calculate coronary artery dimensions and degree of stenosis per vessel and coronary plaque composition and burden. 4
Calcified Plaque - Higher density plaque, mostly composed of calcium, thought to be associated with lower clinical risk than non-calcified plaque. Traditionally, the overall burden of calcified plaque has been assessed indirectly through a coronary artery calcium score (CACS) or using cut off >350 HU. 5 There is both calcified and non-calcified tissue present. 6
Coronary Artery Disease (CAD)- Narrowing of the coronary arteries usually caused by plaque and atherosclerosis that can lead to ischemia of the heart. 1
• Known CAD includes patient with prior anatomic testing with identified nonobstructive atherosclerotic plaque and obstructive CAD. 1
Coronary Artery Disease Reporting and Data System (CAD-RADS)- A standardized method to communicate findings of CCTA. 2
Category
Degree of maximal coronary stenosis
Interpretation
CAD-RADS 0
0%
Absence of CAD
CAD-RADS 1
1-24%
Minimal non-obstructive CAD
CAD-RADS 2
25-49%
Mild non-obstructive CAD
CAD-RADS 3
50-69%
Moderate stenosis
CAD-RADS 4
70-99% or left main ≥50% or 3-vessel obstructive (≥70%) disease
Severe stenosis
CAD-RADS 5
100%
Total coronary artery occlusion or sub-total occlusion
CAD-RADS N
Non-diagnostic study
Obstructive CAD cannot be excluded
Coronary Computed Tomography Angiography (CCTA) - a non-invasive test using advanced computed tomography angiography imaging to view the tissues and blood vessels of the heart. This can be used to determine the presence and extent of CAD.
Coronary Plaque Analysis (CPA)- Analysis of coronary plaque composition and burden.
Fibrotic Plaque- a plaque with density of 131-350 HU.
High Risk Plaque (HRP)- High risk plaque findings include napkin-ring sign, low-attenuation plaque, positive vessel remodeling, low CT attenuation and spotty calcification. 5,7
Invasive Coronary Angiography (ICA)- Invasive procedure done at the time of cardiac catheterization to look at the arteries of the heart and can determine the presence and extent of CAD.
Low Attenuation Plaque (LAP)- Low density plaque with dark appearance on CCTA and higher lipid content usually defined as attenuation of 5,8
Major Adverse Cardiac Events (MACE)- Fatal and non-fatal myocardial infarction. Some studies also include unstable angina requiring hospitalization or revascularization. 7
Non-Calcified Plaque (NCP) – A lower density plaque, often earlier in development and associated with higher clinical risk with density of 50-130 HU. 5,8 There is no discernible calcification present. 6
Nonobstructive CAD - CAD with 1
Obstructive CAD- CAD with >50% stenosis 1
Plaque - The presence of tissue structures ≥ 1mm2 within or adjacent to the coronary artery lumen, identified and at least two independent planes, that can be distinguished from the surrounding tissues (epicardial fat) and the lumen.6
Quantitative Coronary Plaque Analysis (QCPA)- Imaging technique that provides objective and reproducible measurements of coronary artery dimensions and composition of the atherosclerotic plaques.
Quantitative Coronary Topography (QCT)- CT scan imaging that provides objective and reproducible measurements of the coronary artery dimensions and degree of stenosis per vessel.
Provider Qualifications
The Medicare Program Integrity Manual states services will be considered medically reasonable and necessary only if performed by appropriately trained providers.
Patient safety and quality of care mandate that healthcare professionals who interpret CCTA and QCPA and AI-QCT/AI-CPA are appropriately trained and/or credentialed by a formal residency/fellowship program. Credentialing or privileges are required for procedures performed in inpatient and outpatient settings. 4
All aspects of care must be within the provider’s medical licensure and scope of practice. Reimbursement for procedures utilizing imaging techniques may be made to providers who meet training requirements for the procedures in this policy only if their respective state allows such in their practice act and formally licenses or certifies the practitioner to use and interpret these imaging modalities. At a minimum, training must cover and develop an understanding of anatomy and drug pharmacodynamics and kinetics as well as proficiency in diagnosis and management of disease, the technical performance of the procedure, and utilization of the required associated imaging modalities. Supervision, interpretation, and reports shall/must be performed by a physician with the advanced training requirements and or credentialing for CCTA and AI-QCT/AI-CPA. The technical and professional portions must meet the criteria for performance for CCTA.
Providers must also meet the FDA requirements which includes “The software is not intended to replace the skill and judgment of a qualified medical practitioner and should only be used by people who have been appropriately trained in the software’s functions, capabilities and limitations.” 9 Radiology technicians must also meet all training requirements for performance of AI-QCT/AI-CPA.
Notice: Services performed for any given diagnosis must meet all the indications and limitations stated in this LCD, the general requirements for medical necessity as stated in CMS payment policy manuals, all existing CMS national coverage determinations, and all Medicare payment rules.
Summary of evidence (opening)
A Contractor Advisory Meeting “ Non-Invasive Technology for Coronary Artery Plaque Analysis” was hosted 5/25/23 by CGS Administrators, Noridian Healthcare Solutions, National Government Services, Palmetto GBA, and WPS Government Health Administrators. The transcript and audio are available on each MACs website.
Background
CCTA has become an effective gate keeper for invasive angiography helping guide referral for obstructive CAD. It has been demonstrated to be superior to exercise electrocardiography and single-photon emission computed tomography (SPECT) for detection of obstructive CAD (>50% stenosis). 10,11 . Studies have demonstrated excellent prognostic value of a normal CCTA for both short and long term mortality rates. 12 The updated 2021 American College of Cardiology and American Heart Association Chest Pain Guideline 1 states CCTA has become a first line tool in evaluation of acute and chronic coronary artery disease particularly in symptomatic patients with stable symptoms and intermediate or high pre-test probability of obstructive coronary artery disease, or among intermediate-risk acute chest pain patients.
CCTA can also provide information on plaque burden and adverse coronary artery plaque characteristics which has been demonstrated to be an independent predictor of disease and prognosis. 12 The characterization of coronary atherosclerotic plaques can be calculated from CCTA, but the process is time consuming and often with variable results. 4,13 At least 5 different software have been developed as an adjunct to CCTA to aid in the visualization, reduce evaluation time, and improve accuracy of this assessment. The gold standard is considered intravascular ultrasound (IVUS) and optical coherence tomography (OCT) which are the tools that are often used to validate the software. 5 This is intended to improve clinical diagnosis and management of CAD. 14
The contractor cites 80 sources in the bibliography; the full summary and analysis of evidence are in the CMS record.
Dates, lineage and related policies
- Original determination effective
- 2024-12-08
- Current revision effective
- 2025-10-16
- MCD version
- 9
The contractor lists one National Coverage Determination as related: NCD 220.1 Computed Tomography. Where an NCD speaks, it controls; the LCD can only address what the NCD leaves open.
Other related documents: A59935 (Response to Comments), A59936 (Response to Comments).
Using this policy on a claim
Match the documented indication to the covered indications above before the service is scheduled, carry a diagnosis from the article's covered list on the claim line, and keep the elements the documentation section asks for in the record, because the contractor can request it later through medical review. A denial under this policy arrives as CARC 50 with remark N115; the LCD lookup guide walks through the appeal path and the Advance Beneficiary Notice rules, and the Noridian Healthcare Solutions, LLC hub lists every other active policy from the same contractor.
The same policy title at other contractors
Contractors often adopt each other's policies and then revise them separately, so the criteria and the diagnosis lists drift apart. The topic comparison lines up every version.
Frequently asked questions
What does LCD L39881 cover?
AI-QCT/AI-CPA should not be performed until after the base study (CCTA) has been completed and interpreted. Software to perform AI-QCT/AI-CPA must be FDA cleared or approved. The full indications and limitations are reproduced on this page from the CMS Medicare Coverage Database export of September 24, 2026.
Which states does LCD L39881 apply to?
Noridian Healthcare Solutions, LLC applies it to Medicare claims in AK, AS, AZ, CA, CNMI, GU, HI, ID, MT, ND, NF, NV, OR, SD, SF, UT, WA, WY. A Local Coverage Determination binds only the contractor that wrote it; the same service in another jurisdiction is judged under that contractor's own policy or, where none exists, claim by claim.
Which diagnosis codes support medical necessity under LCD L39881?
The companion billing and coding article A59769 lists 1 ICD-10-CM codes in 1 group that support medical necessity; the first 1 appear on this page and the complete list is in the article on cms.gov.
How do I appeal a denial under LCD L39881?
The remittance carries claim adjustment reason code 50 with remark code N115, naming the LCD. Compare the documented indication with the policy's covered indications and the article's diagnosis list, then file a redetermination within 120 days with the record attached; if the service genuinely falls outside the policy, the patient can be billed only when a valid Advance Beneficiary Notice was obtained before the service.
Sources
Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-02. Verify against the primary file before billing or contracting decisions.
- Medicare Coverage Database, current LCD exportVersion MCD release 2026-09-24 · effective 2026-09-20 · file lcd.csvSHA-256 2fcc4251b6ddd1eb…
- Medicare Coverage Database, current Billing and Coding Articles exportVersion MCD release 2026-09-24 · effective 2026-09-20 · file article.csvSHA-256 f31932f1df3b4035…
- ICD-10-CM FY2027 code descriptionsVersion FY2027 · effective 2026-10-01 · file icd10cm_codes_2027.txtSHA-256 3c0583a38ee0e848…
Disclaimer
The policy text and code lists are reproduced from the CMS Medicare Coverage Database export as an operational reference. Verify against the current LCD and article on cms.gov before billing; coverage depends on the full record and the contractor. Not legal, clinical or billing advice.