National Heritage Insurance Company - (Local Carrier 99—San Diego)
Coronary Artery Calcium Scoring (CACS) Medicare Information
Effective November 27, 2006

---

Medicare approved uses of CACS include:

• Chest pain of suspected cardiac etiology or clear evidence of myocardial ischemia to determine the appropriateness of Cardiac CT Angiography versus catheter angiography.

• Further risk stratification for lipid lowering therapy in patients with an intermediate to high Framingham Risk Score. Two of the following should be present: diabetes, metabolic syndrome, hypertension, family history of cardiac or vascular disease, lipid abnormalities, smoking or obesity. (Since most patients will be over age 65, this is a total of 3 Framingham risk factors.)

• Equivocal stress imaging test or in cases with discordance between stress testing and clinical findings