Current Procedural Terminology (CPT) codes are standardized numerical codes used by medical professionals in the United States to describe and report services to payers and insurers. CPT Code 75571 is a specific code designated for a particular type of non-invasive cardiac imaging procedure. This code allows healthcare facilities to bill for a specialized computed tomography (CT) scan focused on assessing heart health.
The Procedure Defined
CPT 75571 specifically describes a “Computed tomography, heart, without contrast material, with quantitative evaluation of coronary calcium.” This procedure is commonly known as Coronary Artery Calcium (CAC) scoring, which uses a standard CT scanner to take rapid, low-dose X-ray images of the heart. The scan is performed without the injection of an intravenous contrast dye, making it a quick and non-invasive examination focused solely on detecting calcified plaque.
The technology is designed to identify and measure the amount of calcification, or hardened plaque, within the walls of the coronary arteries. Since calcification only occurs in areas where atherosclerotic plaque is present, this measurement serves as a direct indicator of the total burden of coronary atherosclerosis. The entire process takes only a few minutes to complete, though the analysis requires specialized software.
The quantitative evaluation mentioned in the code is typically reported using the Agatston score, a numerical value calculated by multiplying the area of the calcified lesion by a density factor. A score of zero indicates no detectable coronary plaque, suggesting a low likelihood of a near-term cardiac event. Scores ranging from 1 to 99 are considered mild, scores of 100 to 399 are moderate, and scores of 400 or greater signify extensive calcification.
Clinical Application and Patient Selection
The primary clinical utility of the CAC score is to improve cardiovascular risk stratification in asymptomatic individuals. The goal is to refine a patient’s risk assessment beyond traditional risk factors, such as cholesterol levels, blood pressure, and smoking history. The test is most often medically appropriate for asymptomatic patients deemed to be at intermediate risk for a future cardiovascular event.
For this intermediate-risk group, the CAC score helps guide decisions regarding preventive therapy, such as starting a statin medication. A high Agatston score may prompt a physician to recommend aggressive risk-reduction strategies. Conversely, a score of zero in an intermediate-risk patient may suggest that statin therapy could be safely deferred, allowing for a personalized approach to prevention. The test is considered a screening tool used to predict future risk, rather than a diagnostic tool for people presenting with active symptoms like chest pain.
Distinction from Other Cardiac CT Codes
The CPT code 75571 is distinct from other cardiac CT codes because it is a non-contrast study focused exclusively on calcium measurement.
Contrast-Enhanced CT Codes
CPT 75572 describes a computed tomography of the heart with contrast material for evaluating cardiac structure and morphology, focusing on the heart muscle and chambers. CPT 75573 is a contrast-enhanced CT reserved for evaluating cardiac structure in the setting of congenital heart disease.
The most significant difference is with CPT 75574, which represents a Computed Tomographic Angiography (CTA) of the heart, coronary arteries, and bypass grafts, performed with contrast and including complex 3D post-processing. This advanced procedure provides detailed images of the coronary artery lumens to visualize blockages.
Because the comprehensive studies described by codes 75572 through 75574 are more complex and contrast-enhanced, they already include a quantitative calcium assessment if one is performed during the same session. Therefore, CPT 75571 is generally reported only when calcium scoring is performed as a stand-alone procedure.
Reimbursement and Billing Considerations
Coverage for CPT 75571 varies considerably because the procedure is often classified as a preventive screening tool rather than a medically necessary diagnostic test. Government programs, such as Medicare, frequently do not cover coronary calcium scoring, as federal regulations often exclude true screening exams from reimbursement. Medicare beneficiaries may be required to sign an Advance Beneficiary Notice of Noncoverage (ABN) acknowledging responsibility for the cost.
Private insurance coverage is also inconsistent, with many payers considering the procedure experimental or investigational unless the patient meets specific, high-risk criteria defined in their policy. To secure reimbursement, the claim must include appropriate diagnostic codes (ICD-10 codes) demonstrating medical necessity. When coverage is denied, patients often pay for the test out-of-pocket through self-pay programs.