Criteria for Calcium Scoring by Computed Tomography

1. Coronary artery calcium (CAC) scoring is a test that is noninvasive and is used for cardiovascular risk assessment by measuring the location and extent of calcium in the coronary arteries. In general it is a better marker of the extent of coronary atherosclerosis than the severity of stenosis.
   • Coronary artery calcium scoring by computed tomography is considered medically necessary for cardiovascular risk assessment in the following: 
     1. Asymptomatic persons with an intermediate (10% to 20%) 10-year risk of cardiac events based on Framingham Risk Scoring or Pooled Cohort Equations.
     2. Measurement of CAC may be reasonable for cardiovascular risk assessment in persons at low to intermediate risk (6% to 10% 10-year risk).
     3. Asymptomatic persons age 40 years and older with diabetes.
   • Coronary Artery Calcium Scoring may not be useful/ effective under the following circumstances:
     1. In patients at low (<10 percent, 10 year risk) or high (>20 percent, 10-year) CHD risk as established by the Framingham risk score and modified Framingham / ATP risk scores.
     2. As a measure to establish the presence of obstructive disease for subsequent revascularization.
     3. Serial or repeat calcium scoring is not recommended as it is considered experimental and investigational.
2. Aortic valve calcium can be quantitated using multidetector CT (MDCT), which is a high-resolution form of CT and may be useful in early identification of calcific aortic valve disease and in determining if stenosis is severe, particularly in patients with low-flow, low-gradient aortic stenosis.

Effective: 1/1/2026