Radiology Coding Alert

Question: I’ve been getting medical necessity denials from NGS Medicare for computed tomography (CT) calcium score exams. Can we appeal these denials?

Alaska Subscriber

Answer: National Government Services, Inc. (NGS) Medicare will not reimburse for code 75571 (Computed tomography, heart, without contrast material, with quantitative evaluation of coronary calcium). Have a look at the NGS Medicare Local Coverage Determination (LCD) policy (L33629) on 75571 reimbursement:

• “Quantitative calcium scoring (CPT^® 75571) is not a covered service and will be denied as not medically necessary. Calcium scoring reported in isolation is considered a screening service. When performed in association with CT angiography, there is neither separate nor additional included reimbursement for the calcium scoring.”

For patients receiving this service, you may want to consider issuing the patient an advance beneficiary notice (ABN) beforehand to ensure that the patient will pay out of pocket for the service once NGS Medicare denies it.