Whether insurance covers CPT code 75571 depends on who insures you, why the scan was ordered, and where you live. Traditional Medicare almost always denies a standalone coronary artery calcium (CAC) scan as not medically necessary. Commercial plans are split: some cover it for intermediate-risk adults who meet specific clinical criteria, others label it investigational and pay nothing. Three states — Texas, New Mexico, and Maryland — require certain insurers to cover it for eligible patients, which is the most dependable path to coverage.
Medicare Rarely Pays for a Standalone Calcium Score
Medicare coverage is set regionally by Medicare Administrative Contractors (MACs) through Local Coverage Determinations. Most MACs deny CPT 75571 outright. Wisconsin Physicians Service (LCD L35121), National Government Services (LCD L33559), and CGS Administrators (LCD L33947, covering Kentucky and Ohio) all state that “quantitative calcium scoring is not a covered service and will be denied as not medically necessary,” treating a calcium score reported on its own as a screening service.1CMS.gov. LCD for Cardiac Computed Tomography and Coronary Computed Tomography Angiography, L339472SCCT. CMS Medicare Administrative Contractor Policies
If a calcium score is produced during a coronary CT angiogram (CCTA), none of these MACs pay anything extra for the calcium scoring component. Palmetto GBA (LCD L33423, covering Alabama, Georgia, Tennessee, Virginia, and the Carolinas, among others) likewise does not cover screening CCTA for asymptomatic patients or “quantitative evaluation of coronary calcium.”3CMS.gov. Billing and Coding Article A56691 for Cardiac CT Angiography
There is one narrow opening. Palmetto’s billing article A56691 lists CPT 75571 among procedures that can be supported by certain ICD-10 diagnoses — conditions such as angina, atherosclerotic heart disease, heart failure, and congenital cardiac malformations — when the medical record documents that the LCD’s coverage criteria are met. A patient in Palmetto’s territory with an established cardiac diagnosis may not see an automatic denial, but this is the exception.4CMS.gov. Billing and Coding Article A56691 for Cardiac CT Angiography
Commercial Insurance Coverage Varies by Carrier
Private payers do not agree on this test. Some have built coverage criteria around intermediate cardiovascular risk; others deny it as investigational.
Aetna
Aetna considers a single calcium score medically necessary for asymptomatic adults 40 and older with diabetes, and for asymptomatic adults with a 10-year cardiac event risk of 10 to 20 percent calculated by the Framingham Risk Score or the Pooled Cohort Equations. A repeat scan is covered only if the most recent score was zero, at least five years have passed, and finding calcium would change clinical management. Other uses are considered experimental, investigational, or unproven.5Aetna. Clinical Policy Bulletin 0228 – Cardiac CT, Calcium Scoring
Blue Cross Blue Shield
Blue Cross policies are set by state affiliate. Florida Blue covers CAC testing for members ages 40 to 75 without established cardiovascular disease who have an intermediate-to-low 10-year risk (5 to 20 percent), when the result would guide a decision such as whether to begin statin therapy. Repeat testing is allowed after at least five years if a new result would change management, but is not covered if the patient has had two zero scores five years apart or already has a score of 400 or above.6BCBS Florida. Coronary Artery Calcium Testing Medical Coverage Guideline
Blue Cross Blue Shield of Mississippi considers CT detection of coronary artery calcification — under both CPT 75571 and HCPCS S8092 — investigational and not medically necessary.7BCBS Mississippi. Computed Tomography to Detect Coronary Artery Calcification Blue Cross Blue Shield of Texas’s general policy says the test is not medically necessary, but Texas state law requires coverage for eligible patients regardless.8BCBS Texas. Medical Policy RAD604.009 – CT to Detect Coronary Artery Calcification
Anthem
Anthem requires prior authorization for CPT 75571, evaluated against AIM Specialty Health criteria. Requests go through the AIM provider portal or Availity.9Anthem. CT to Detect Coronary Artery Calcification – Prior Authorization
UnitedHealthcare
UnitedHealthcare includes CPT 75571 on its prior authorization code list for commercial and Individual Exchange plans. Specific clinical criteria are not spelled out in the public document, so providers verify through the UHC portal.10UnitedHealthcare. Radiology Prior Authorization CPT Code List
Cigna
Cigna manages cardiac imaging authorizations through EviCore, whose guidelines include a dedicated section for coronary calcium scoring.11EviCore. Cigna Cardiac Imaging Guidelines V1.0.2026 EviCore’s general position is that standalone calcium scoring is investigational in asymptomatic patients, though indicated for symptomatic individuals with a very low or low pretest probability of coronary artery disease.12SCCT. EviCore Coverage Policy for Cardiac CT and CTA A 2024 Cigna policy update also treats a CAC score of 300 or greater as one pathway to eligibility for certain lipid-lowering therapies.13Cigna. Policy Updates – August 2024
States That Require Coverage
A few states have passed laws forcing insurers to cover CAC scans for eligible patients. These mandates override insurer policies that would otherwise deny the test.
Texas
Texas House Bill 1290, signed in 2009, requires health benefit providers in the state to cover a CT coronary artery calcium scan (or carotid ultrasound) once every five years, up to $200 per test. Eligible patients are men ages 45 to 75 and women ages 55 to 75 who are diabetic or who have an intermediate or higher risk of coronary heart disease on the Framingham algorithm. The mandate reaches individual, group, small employer, and Medicare supplemental plans, among others.14Texas Legislature. HB 1290 Bill Analysis15AuntMinnie. Texas-Sized Heart Screening Law Set for September Debut
New Mexico
New Mexico House Bill 126 took effect January 1, 2021. It requires coverage of a CAC scan every five years for individuals ages 45 to 65 with intermediate 10-year cardiovascular risk under an evidence-based algorithm such as the Pooled Cohort Equations. Repeat scans are required only if the prior score was zero. The law covers individual and employer-sponsored plans but excludes Medicaid, Medicare, and certain limited-benefit policies.16New Mexico Legislature. HB 126 – Heart Artery Calcium Scans17KRWG News. UNM Doctors Push to Expand Insurance Coverage for Coronary Artery Calcium Screening
Maryland
Maryland is the newest state to mandate coverage. Governor Wes Moore signed HB 666 (Chapter 684) on May 20, 2025. For policies issued or renewed on or after January 1, 2026, insurers, nonprofit health service plans, HMOs, managed care organizations, and the Maryland Medical Assistance Program must cover calcium score testing in line with the most recent American College of Cardiology guidelines.18BillTrack50. MD HB666 – Calcium Score Testing Coverage
Why the Coverage Picture Is So Uneven
The split comes from a disagreement over whether a calcium score is screening or diagnostic. Medicare classifies the standalone test as screening, and federal law bars Medicare from paying for screening services without specific congressional authorization. That has driven most MACs to deny CPT 75571.
The U.S. Preventive Services Task Force added to the uncertainty. In its 2018 recommendation, the USPSTF found the evidence “insufficient to assess the balance of benefits and harms” of adding CAC scoring to traditional cardiovascular risk assessment for asymptomatic adults, saying there was “inadequate evidence to assess whether treatment decisions guided by CAC score test results lead to reduced incidence of CVD events or mortality.”19USPSTF. Cardiovascular Disease Screening Using Nontraditional Risk Assessment That “I” (insufficient) rating gives insurers cover for denying the test. The USPSTF is updating the recommendation; as of late 2024, the topic had progressed past the final research plan stage with public comments closed.20USPSTF. Enhanced Risk Assessment for Cardiovascular Disease – Update in Progress The Society of Cardiovascular Computed Tomography, the American College of Cardiology, and the American College of Radiology have urged the USPSTF to upgrade calcium scoring to a “C grade,” which would widen insurance coverage.21SCCT. SCCT Letter to USPSTF on CAC Scoring Recommendation
On the other side, the 2018 AHA/ACC cholesterol guidelines give the insurers who do cover the test a framework. Those guidelines recommend considering CAC scoring for adults ages 40 to 75 without diabetes who have LDL cholesterol between 70 and 189 mg/dL and a 10-year ASCVD risk of 7.5 to 19.9 percent, when the statin decision is uncertain.22AHA Journals. 2018 AHA/ACC Guideline on the Management of Blood Cholesterol Aetna and Florida Blue built their coverage rules around exactly those thresholds.
What You’ll Pay If Insurance Doesn’t Cover It
Many patients pay for the scan themselves. Self-pay prices usually run $100 to $400, with most imaging centers in the $100 to $150 range. Urban medical centers in cities such as New York, Los Angeles, and Miami often charge $300 to $400; suburban and regional facilities can run as low as $50 to $150.23American Heart Association. Coronary Artery Calcium Test24Cigna. Coronary Calcium Scan The scan is an eligible medical expense under Health Savings Accounts and Flexible Spending Accounts, so you can pay with pre-tax dollars.
How to Appeal a Denied Claim
You have the right to appeal. Federal law requires insurers to tell you why a claim was denied and how to challenge it. The process has two stages: an internal appeal, in which the insurer reviews the decision, and — if that fails — an external review by an independent third party.25HealthCare.gov. How to Appeal an Insurance Company Decision
Internal appeals generally must be filed within 180 days of the denial. For a medical necessity denial, the ordering physician’s documentation is the core of the case: evidence of intermediate cardiovascular risk, the specific AHA/ACC guideline criteria the scan meets, and the pending clinical decision — such as whether to start a statin — that the result would inform. If you live in a state with a coverage mandate, cite the statute by name in your appeal letter. The insurer’s general medical policy does not override state law for the plan types the mandate reaches.