A Coronary Artery Calcium (CAC) test is a non-invasive imaging procedure used to assess an individual’s risk for future cardiac events. This scan provides a specific measure of calcified plaque, which is a key indicator of underlying coronary artery disease. Understanding the cost is important because the price can fluctuate significantly, and coverage by health insurance plans is often inconsistent.
Understanding the Coronary Artery Calcium Test
The CAC test is a specialized, non-invasive computed tomography (CT) scan of the chest performed without the use of an intravenous contrast dye. Its primary function is to detect and measure the amount of calcified plaque within the coronary arteries. Calcified plaque is a hardened form of atherosclerosis, the buildup of fatty deposits in the artery walls.
The presence and quantity of this calcium directly correlate with the total burden of atherosclerotic plaque. The procedure is quick, typically taking less than 10 minutes, and requires no special preparation other than avoiding caffeine and smoking beforehand. The resulting numerical value, known as the Agatston score, helps healthcare providers refine an individual’s long-term risk of heart attack or stroke.
Average Cost and Price Variability
The typical out-of-pocket self-pay price for a Coronary Artery Calcium test generally falls within a range of $100 to $400. Some facilities offer promotional or discounted rates starting as low as $50, while others might charge closer to $400, depending on the region. The average out-of-pocket cost is often cited to be around $100 to $150 nationwide.
The price variability is largely determined by the type of facility performing the scan and the geographic location. Hospitals often charge higher fees for the procedure than independent, outpatient imaging centers. Local market competition and promotional deals can also lead to discounted flat-rate pricing for self-pay patients.
Many clinics offer discounted cash rates for individuals paying upfront without involving insurance, which can streamline the billing process and lower the final cost. It is advisable to compare prices among local providers, as some may include the radiologist’s interpretation and a follow-up consultation in their flat-rate package. The self-pay option is frequently the most transparent way to obtain the test.
Insurance Coverage and Payment Options
For many patients, the CAC test is classified as a screening or preventative measure, meaning it is frequently not covered by standard commercial insurance plans or Original Medicare. Coverage is typically restricted unless the patient presents with specific symptoms or meets high-risk criteria, which shifts the test’s classification from preventative screening to diagnostic testing. The test is often not considered “reasonable and necessary” under standard Medicare guidelines.
Some private insurers, such as Anthem, UnitedHealthcare, and Aetna, have begun to offer favorable coverage decisions for the CAC test, though patients may still be required to meet their deductible first. While professional guidelines support the use of the CAC score to guide treatment decisions, this has not yet translated into universal coverage by insurance payers. Paying the upfront cash price is often the most straightforward payment option for this test.
Interpreting the CAC Score
The result of the CAC test is a numerical value, known as the Agatston score, which quantifies the volume and density of calcified plaque. A score of zero indicates that no calcified plaque was detected, which is associated with a very low risk of a heart attack over the next several years. However, a score of zero does not rule out the presence of “soft,” non-calcified plaque, especially in younger individuals.
Scores are generally categorized to determine the level of risk. A score between 1 and 99 indicates mild disease, while a score from 100 to 399 suggests moderate plaque levels and a relatively higher risk. A score of 400 or more is considered extensive and is associated with a severe calcium burden, indicating a high risk of a future cardiovascular event. The score helps guide decisions about lifestyle changes and preventative medication.