Does United Healthcare Cover Coronary Calcium Scans?

In most cases, UnitedHealthcare does not cover coronary calcium scans. The insurer’s policy treats coronary artery calcium scoring as “investigational in asymptomatic patients with any degree of CAD risk,” which means a standalone screening scan is generally not a covered benefit.¹ Coverage opens up only in narrow situations: certain state mandates, a scan performed as part of a diagnostic workup for a symptomatic patient, and a few specific clinical scenarios. If you’re paying out of pocket, the test typically runs between $50 and $400.²

The Default Rule

UnitedHealthcare’s commercial medical policy classifies calcium scoring performed as a standalone test as investigational for asymptomatic patients, regardless of their underlying cardiovascular risk level.¹ An investigational designation functions as a non-coverage decision: the insurer does not consider the service medically necessary, and claims are typically denied.

The scan is billed under CPT code 75571, a non-contrast CT of the heart with quantitative calcium evaluation. UnitedHealthcare’s policy says this code should only be reported for standalone calcium scoring and should not be combined with contrast-enhanced cardiac CT or coronary CT angiography codes (CPT 75572 through 75574).¹ If you see CPT 75571 on a cost estimate or explanation of benefits, that’s the line item that UnitedHealthcare’s policy flags.

When Coverage Is Possible

State Mandates

Three states require insurers to cover calcium scoring, and UnitedHealthcare has to comply for fully insured plans issued in those states.

Texas. The Heart Attack Prevention Bill (HB 1290), signed in 2009, requires health benefit plans to cover either a calcium scoring CT or a carotid intima-media thickness study once every five years.³ To qualify, you must be a Texas resident on a fully insured plan, be a man between 45 and 75 or a woman between 55 and 75, and either have diabetes or score at intermediate-or-higher risk on the Framingham scale. Coverage is capped at $200 per test.⁴

Maryland. Governor Wes Moore signed HB 666 on May 20, 2025, requiring insurers, HMOs, and the state Medicaid program to cover calcium score testing consistent with current American College of Cardiology guidelines.⁵ The mandate applies to policies issued or renewed on or after January 1, 2026, and the statute does not set a dollar cap.⁶

New Mexico. HB 126, effective January 1, 2021, requires coverage for insured individuals aged 45 to 65 at intermediate risk, with repeat scans every five years only if the initial score was zero.⁷

As Part of a Diagnostic Workup

If a cardiologist orders calcium scoring as a component of a diagnostic cardiac CT or coronary CT angiography for a patient with symptoms, UnitedHealthcare treats it differently from screening. The calcium measurement is bundled into the diagnostic procedure code rather than billed separately, and coverage then depends on whether the overall imaging meets medical necessity criteria rather than on the standalone calcium scoring policy.¹ UnitedHealthcare updated its policy in 2020 to reimburse coronary CT angiography as a first-line test for stable chest pain in patients with low or intermediate risk, with automatic prior authorization approval for providers who select CTA.⁸

Symptomatic Patients With Low Pretest Probability

UnitedHealthcare’s policy identifies calcium scoring as an appropriate indication for symptomatic individuals with a “very low” or “low” pretest probability of coronary artery disease.¹ That is a narrow clinical niche, distinct from screening use in people without symptoms.

The Self-Funded Plan Catch

Living in a mandate state does not guarantee coverage. State insurance mandates only reach fully insured plans. Self-funded employer plans are governed by federal ERISA law and are exempt from state insurance mandates.⁹ UnitedHealthcare’s own product comparison confirms that state-mandated benefits are “not applicable” to its level-funded (self-funded) plans because “ERISA applies.”¹⁰

A Texas or Maryland resident on a self-funded UnitedHealthcare plan through their employer may not benefit from those states’ coverage laws at all. Your plan’s Summary Plan Description will usually indicate whether the plan is fully insured or self-funded. If you don’t know, ask your HR or benefits office before scheduling the test.

UnitedHealthcare Medicare Advantage

Traditional Medicare does not cover calcium scoring. The Local Coverage Determination maintained by Palmetto GBA explicitly states that Medicare does not cover screening coronary CT angiography for asymptomatic patients, risk stratification, or “quantitative evaluation of coronary calcium.”¹¹ Because Medicare Advantage plans must provide benefits at least equivalent to original Medicare, UnitedHealthcare’s Medicare Advantage products carry the same non-coverage.¹²

One note on process: Medicare Advantage members, including those in Dual Special Needs Plans, are exempt from UnitedHealthcare’s prior authorization requirement for CT scans.¹³ That exemption is about paperwork; it does not create coverage where the underlying policy excludes the service.

Prior Authorization

For most commercial UnitedHealthcare plans, advanced outpatient imaging including cardiac CT requires prior authorization. Providers submit requests through the UnitedHealthcare Provider Portal. Emergency room, urgent care, and inpatient settings are exempt from prior authorization, as are Medicare Advantage and Dual Special Needs Plan members.¹³ If your plan requires it, make sure the ordering clinician’s office has filed the authorization before the appointment; a scan performed without an approved authorization is a predictable denial.

If Your Claim Is Denied

UnitedHealthcare uses a two-step dispute process. The first step is a claim reconsideration request. If that doesn’t resolve it, a post-service appeal follows. Providers have 12 months to complete both steps and are directed to submit requests digitally through the provider portal. Before a formal appeal, the ordering physician can request a peer-to-peer review with a UnitedHealthcare medical director; for outpatient cases the request must be made within 21 calendar days of the denial.¹⁴

As the member, your deadlines are shorter. Commercial plan members generally have 65 calendar days from the date on the denial letter to file an appeal. Medicare Advantage members have 60 days. Missing those windows forfeits the right to appeal, so pull the denial letter and calendar the deadline the day you receive it.

Paying Out of Pocket

Because coverage is the exception rather than the rule, many patients simply pay for the scan directly. Typical pricing runs from $100 to $400, though some hospitals and imaging centers have brought the cash price down to between $50 and $100.² Advertised rates can go lower; Northwestern Medicine, for example, has listed the test at $60.¹⁵ Prices vary by facility and location, and some centers quote a lower rate for patients paying cash than for billed insurance claims, so it’s worth calling a few imaging centers in your area before scheduling.

1
SCCT. UnitedHealthcare Coverage Policy
2
AHA Journals. Coronary Artery Calcium Testing
3
Texas Legislature Online. HB 1290 Bill Analysis
4
Medscape. Texas Heart Attack Prevention Bill Signed Into Law
5
Maryland General Assembly. HB 666 – Required Coverage for Calcium Score Testing
6
New York Codes, Rules and Regulations. MD Code, Insurance, § 15-863
7
BCBS of Texas Medical Policy. Computed Tomography for Coronary Artery Calcium Scoring
8
Radiology Business. United Healthcare to Reimburse Coronary CT Angiography
9
UnitedHealthcare. Radiology and Cardiology Clinical Guidelines
10
UnitedHealthcare. Level Funded vs. Fully Insured Comparison Grid
11
CMS. LCD for Cardiac Computed Tomography and Angiography (L33423)
12
UHCProvider.com. Radiology and Cardiology Clinical Guidelines
13
UHCProvider.com. Radiology Prior Authorization
14
UHCProvider.com. Appeals and Reconsiderations
15
Healthline. Coronary Calcium Scan Cost