Does C9793 require prior authorization?

Yes, C9793 requires prior authorization (high confidence). At least one active policy explicitly requires prior authorization.

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`C9793`, 3d predictive model generation for pre-planning of a cardiac procedure, using

HCPCS/CPT

Prior Authorization

Prior Auth Required

At least one active policy explicitly requires prior authorization (high confidence)

Documentation Required

Medical necessity documentation must meet the requirements of the applicable NCD and/or LCD for the service and the MAC jurisdiction (Humana will apply the referenced LCD criteria; where no LCD exists in jurisdiction, Humana applies the specified LCD used as the surrogate in this policy).
For FFR_CT, documentation that the CCTA dataset is of adequate quality to permit valid FFR_CT analysis (policy notes: 'The accuracy of FFR_CT depends on the quality of the CCTA study').
Documentation of clinical indication(s) such as signs/symptoms (e.g., chest pain/pressure/discomfort), known or suspected CAD, congenital coronary anomalies, thoracic aortic disease, valvular heart disease, or other clinical scenarios cited in the applicable LCD supporting use of CCTA/FFR_CT/CACS.

Key Coverage Criteria

Coronary computed tomography angiography (CCTA) as a noninvasive alternative to invasive cardiac angiography (cardiac catheterization) for diagnosing coronary artery disease (CAD) by visualizing blood flow in the coronary arteries.
CCTA for assessment of chest pain/pressure/discomfort.
CCTA for assessment of congenital coronary anomalies.
CCTA for assessment of thoracic aortic disease.
CCTA for assessment of valvular heart disease.
Fractional flow reserve derived from computed tomography (FFR_CT) to evaluate the adequacy of blood flow through the coronary arteries in individuals with known or suspected coronary artery disease (CAD) as a noninvasive alternative to invasive FFR measurement with a pressure catheter.

8 Active Policies

HUMANA-CORONARY-CT-ANGIOGRAPHY-FRACTIONAL-FLOW-RESERVE-WITH-CT-AND-ADJUNCTIVE-TESTING-MA, Coronary CT Angiography, Fractional Flow Reserve with CT and Adjunctive Testing

EVICORE-HPLAN-CIGNA-D342290ED333, Cigna Commercial Cardiology Code List - Effective 03/07/2026

EVICORE-HPLAN-CIGNA-AFCE721BA4F3, Cigna Comprehensive Code List - Effective 03/07/2026

EVICORE-HPLAN-CIGNA_MEDICARE-B17FDA871CCE, Cigna Commercial & Medicare Cardiology & Radiology Code List - Effective 01/01/2026

BCBSIL-SUR707.028, Transcatheter Aortic-Valve Implantation for Aortic Stenosis

BCBSMT-SUR707.028, Transcatheter Aortic-Valve Implantation for Aortic Stenosis

BCBSNM-SUR707.028, Transcatheter Aortic-Valve Implantation for Aortic Stenosis

BCBSOK-SUR707.028, Transcatheter Aortic-Valve Implantation for Aortic Stenosis

`C9793`, 3d predictive model generation for pre-planning of a cardiac procedure, using

Prior Authorization

Documentation Required

Key Coverage Criteria

8 Active Policies

Related Codes

Have a follow-up question?

C9793, 3d predictive model generation for pre-planning of a cardiac procedure, using

Prior Authorization

Documentation Required

Key Coverage Criteria

8 Active Policies

Related Codes

Have a follow-up question?

`C9793`, 3d predictive model generation for pre-planning of a cardiac procedure, using