The Coronary Artery Calcium (CAC) score test is a non-invasive procedure utilizing a specialized Computed Tomography (CT) scan to measure calcified plaque within the coronary arteries. This calcification is a direct marker of atherosclerosis, indicating an increased future risk of a heart attack or other cardiovascular events. The test provides a quantitative score, helping to refine an individual’s risk assessment beyond traditional factors like cholesterol and blood pressure. Obtaining this score involves understanding the medical reasons for the test, the procedural steps to request it, and the practical considerations for scheduling and payment.
Determining Eligibility for the Test
Medical guidelines recommend the CAC test primarily for asymptomatic adults whose risk of a future cardiovascular event is uncertain or intermediate based on standard risk calculators. The procedure is generally considered for men over the age of 40 and women over the age of 50 who possess cardiovascular risk factors but have no history of heart disease symptoms. Current guidelines suggest that the test is most beneficial for individuals with an estimated 10-year risk of atherosclerotic cardiovascular disease (ASCVD) between 5% and 20%.
The score helps reclassify this intermediate-risk group, guiding decisions about preventive medications such as statins. The test is typically not recommended for individuals already known to have low risk (10-year ASCVD risk below 5%). People who have already experienced a heart attack, received a coronary stent, or undergone bypass surgery are also generally excluded because the results would not change their established treatment plan. The primary utility of the CAC score lies in providing a clearer picture of silent disease in an otherwise asymptomatic person.
Initiating the Test Request
The process of ordering a CAC test begins with a conversation with a healthcare provider, such as a primary care physician or a cardiologist, to discuss risk factors and the potential benefit of the scan. The physician can then formally write the necessary medical order for a cardiac CT without contrast, which is the specific imaging request for a CAC score. Providing this medical order to an imaging facility is the traditional method for securing the test.
In some locations, patients can initiate the test through a process known as self-referral, bypassing the need for a physician’s order. This option is typically offered by independent imaging centers or hospitals running specific outreach programs. If pursuing self-referral, the patient contacts the imaging center directly to schedule the appointment and is often required to meet minimum age requirements (e.g., between 40 and 75 years old). Regardless of the path chosen, confirm that the order specifies a non-contrast cardiac CT to generate the Agatston score, as other cardiac CT scans may involve intravenous contrast and different procedural goals.
Financial and Logistical Preparation
A significant logistical step involves assessing the cost and insurance coverage for the CAC score test. Since the test is often classified as a screening tool for asymptomatic individuals, many standard health insurance plans, including original Medicare, do not cover the procedure. Patients should contact their insurance provider before scheduling to confirm coverage status and potential out-of-pocket responsibility.
Because coverage is often denied, the test is frequently paid for entirely by the patient, making comparing facility prices beneficial. The typical out-of-pocket cost for a CAC scan ranges from $100 to $400, though some facilities offer lower promotional or flat rates. When selecting a testing location, choose an accredited imaging center, such as a hospital or specialized clinic, to ensure high-quality images and accurate scoring. Preparation for the scan is minimal, but patients are advised to avoid caffeine and smoking for a few hours prior to the test to ensure a lower heart rate, which helps produce clearer images.
Interpreting Results and Follow-Up Care
The result of the CAC test is a single number known as the Agatston score, which quantifies the area and density of calcified plaque. A score of zero is the most favorable result, indicating no detectable calcified plaque and suggesting a very low risk of a heart attack over the next decade. This score provides a strong negative risk prediction, often allowing a patient and physician to decide against initiating statin therapy.
A score between 1 and 100 indicates minimal to mild plaque deposits, suggesting a higher risk than zero and potentially warranting a discussion about preventive measures such as lifestyle changes or low-dose statins. Scores in the range of 101 to 400 represent moderate plaque burden and a moderately increased risk, often leading to the recommendation of statin treatment and intensive risk factor modification. A score exceeding 400 signifies severe calcification and an established high risk for a future cardiovascular event, which may prompt further diagnostic testing, such as a stress test, and the initiation of high-intensity statin therapy. The Agatston score is not a diagnosis alone but is used by a healthcare professional to refine the overall risk assessment and determine the most appropriate long-term management strategy.