Computerized Axial Tomography (CT), Thorax

LCD Information Document Information Source LCD ID N/A LCD ID L33459 Original ICD-9 LCD ID Not Applicable LCD Title Computerized Axial Tomography (CT), Thorax Proposed LCD in Comment Period N/A Source Proposed LCD N/A Original Effective Date For services performed on or after 10/01/2015 Revision Effective Date For services performed on or after 06/11/2026 Revision Ending Date N/A Retirement Date N/A Notice Period Start Date N/A Notice Period End Date N/A CPT codes, descriptions, and other data only are copyright 2025 American Medical Association. All Rights Reserved. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein. CPT is a registered trademark of the American Medical Association. 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Issue Issue Description This LCD outlines limited coverage for this service with specific details under Coverage Indications, Limitations and/or Medical Necessity. Issue - Explanation of Change Between Proposed LCD and Final LCD CMS National Coverage Policy Title XVIII of the Social Security Act, §1862(a)(1)(A) allows coverage and payment for only those services that are considered reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.Title XVIII of the Social Security Act, §1862(a)(1)(D) items and services related to research and experimentation. Title XVIII of the Social Security Act, §1862(a)(7) states Medicare will not cover any services or procedures associated with routine physical checkups.42 CFR §410.32(b)(3)(i), (b)(3)(ii), (b)(3)(iii) Levels of supervisionCMS Internet-Only Manual, Pub. 100-02, Medicare Benefit Policy Manual, Chapter 6, §20.4.1 Diagnostic Services Defined, §20.4.3 Coverage of Outpatient Diagnostic Services Furnished on or Before December 31, 2009, §20.4.4 Coverage of Outpatient Diagnostic Services Furnished on or After January 1, 2010, and §20.4.5 Outpatient Diagnostic Services Under ArrangementsCMS Internet-Only Manual, Pub. 100-03, Medicare National Coverage Determinations (NCD) Manual, Chapter 1, Part 4, §220.1 Computed Tomography (CT) Coverage Indications, Limitations, and/or Medical Necessity The following clinical indications apply to the computerized axial tomography (CT or CAT) of the thorax: Evaluation of pulmonary, mediastinal, pleural and chest wall infections and their complications Detection and characterization of mediastinal neoplasms and other processes Assessment of cardiopulmonary failure or insufficiency Diagnosis and/or staging of neoplastic and hematologic processes arising in the thorax or with potential involvement of the thorax Detection and determination of nature and extent of cardiovascular abnormalities such as, but not limited to, aneurysm, dissection, embolism, thrombosis, congenital anomalies, postoperative complications and sequelae of atherosclerotic disease For assessing and/or guiding drainage of pulmonary or pleural fluid collections such as abscess, empyema, effusion or pneumothorax For characterizing and follow-up evaluation of interstitial and alveolar lung disease due to idiopathic, allergic, collagen-vascular, environmental or other causes For evaluating thoracic sequelae of remote processes including, but not limited to, pancreatitis, gastrointestinal perforation and other processes For assessing injury, potential injury or thoracic sequelae after trauma, burn, surgery, transplantation, radiation therapy, chemotherapy or invasive procedure such as pacemaker placement, chest tube placement or mechanical ventilation Evaluation of the patient with symptoms that may be arising from the chest, or be referred to the chest including, but not limited to, cough, hemoptysis, chest pain, abdominal pain and others To further characterize a suspected abnormality detected by another imaging test Evaluation of a patient with myasthenia gravis to rule out thymic tumors Performance of CT-guided biopsies and drainage procedures when fluoroscopy is inadequate The most common symptom of an aortic dissection (occurring in approximately 90% of the cases) is sudden, excruciating pain most commonly located in the anterior chest. Patients may describe the pain as "cutting," "ripping," or "tearing". A sudden neurologic episode usually accompanies the onset of most instances of "painless" aortic dissection. NOTE: Radiologic examinations of the chest represent the basic diagnostic tests used to identify abnormalities of the thorax. The chest x-ray and/or physical examination should be used to evaluate patients who present with signs and/or symptoms suggestive of chest pathology prior to proceeding to a CT scan.In addition to the medical necessity requirements, the CT scan must be performed on a model of CT equipment that is recognized by the United States Food and Drug Administration (FDA) and has achieved the full market phase of development. In keeping with American College of Radiology (ACR) Practice Guidelines and Technical Standards, CT thorax should be provided by qualified radiology personnel (radiology technicians, diagnostic radiologists). The patient’s condition should be monitored throughout the procedure. As this involves the patient being in a closed environment, claustrophobia or medical problems exacerbated by the enclosure may be exhibited.Qualified physicians (such as board-certified radiologists) should perform the interpretation of the films. The CT service should be furnished only when clinically appropriate for the patient’s symptoms or complaint. When performed as a screening function, it will not be covered. Summary of Evidence N/A Analysis of Evidence (Rationale for Determination) N/A

The following clinical indications apply to the computerized axial tomography (CT or CAT) of the thorax: Evaluation of pulmonary, mediastinal, pleural and chest wall infections and their complications Detection and characterization of mediastinal neoplasms and other processes Assessment of cardiopulmonary failure or insufficiency Diagnosis and/or staging of neoplastic and hematologic processes arising in the thorax or with potential involvement of the thorax Detection and determination of nature and extent of cardiovascular abnormalities such as, but not limited to, aneurysm, dissection, embolism, thrombosis, congenital anomalies, postoperative complications and sequelae of atherosclerotic disease For assessing and/or guiding drainage of pulmonary or pleural fluid collections such as abscess, empyema, effusion or pneumothorax For characterizing and follow-up evaluation of interstitial and alveolar lung disease due to idiopathic, allergic, collagen-vascular, environmental or other causes For evaluating thoracic sequelae of remote processes including, but not limited to, pancreatitis, gastrointestinal perforation and other processes For assessing injury, potential injury or thoracic sequelae after trauma, burn, surgery, transplantation, radiation therapy, chemotherapy or invasive procedure such as pacemaker placement, chest tube placement or mechanical ventilation Evaluation of the patient with symptoms that may be arising from the chest, or be referred to the chest including, but not limited to, cough, hemoptysis, chest pain, abdominal pain and others To further characterize a suspected abnormality detected by another imaging test Evaluation of a patient with myasthenia gravis to rule out thymic tumors Performance of CT-guided biopsies and drainage procedures when fluoroscopy is inadequate The most common symptom of an aortic dissection (occurring in approximately 90% of the cases) is sudden, excruciating pain most commonly located in the anterior chest. Patients may describe the pain as "cutting," "ripping," or "tearing". A sudden neurologic episode usually accompanies the onset of most instances of "painless" aortic dissection. NOTE: Radiologic examinations of the chest represent the basic diagnostic tests used to identify abnormalities of the thorax. The chest x-ray and/or physical examination should be used to evaluate patients who present with signs and/or symptoms suggestive of chest pathology prior to proceeding to a CT scan. In addition to the medical necessity requirements, the CT scan must be performed on a model of CT equipment that is recognized by the United States Food and Drug Administration (FDA) and has achieved the full market phase of development. In keeping with American College of Radiology (ACR) Practice Guidelines and Technical Standards, CT thorax should be provided by qualified radiology personnel (radiology technicians, diagnostic radiologists). The patient’s condition should be monitored throughout the procedure. As this involves the patient being in a closed environment, claustrophobia or medical problems exacerbated by the enclosure may be exhibited. Qualified physicians (such as board-certified radiologists) should perform the interpretation of the films. The CT service should be furnished only when clinically appropriate for the patient’s symptoms or complaint. When performed as a screening function, it will not be covered.