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ADVANCED IMAGING

8600 West Bryn Mawr Avenue South Tower Suite 800 Chicago, IL 60631 CLINICAL APPROPRIATENESS GUIDELINES ADVANCED IMAGING Appropriate Use Criteria: IMAGING of the Heart EFFECTIVE JANUARY 1, 2022* Proprietary 2022 AIM Specialty Health. All rights reserved. *Not for Anthem Medicaid Approval and implementation dates for specific health plans may vary. Please consult the applicable health plan for more details. AIM Specialty Health disclaims any responsibility for the completeness or accuracy of the information contained herein. IMAGING of the Heart 2022 AIM Specialty Health. All rights reserved. 2 Table of Contents CLINICAL APPROPRIATENESS GUIDELINES .. 1 Appropriate Use Criteria: IMAGING of the Heart .. 1 Table of Contents .. 2 Description and Application of the Guidelines .. 4 General Clinical Guideline .. 5 ADVANCED CARDIAC IMAGING .

• This guideline does not apply to coronary CT angiography (CPT 75574). • This guideline does not apply to cardiac CT for evaluation of cardiac structure and function (CPT 75572 and 75573). Risk assessment • The clinical indication listed for quantitative evaluation of coronary artery calcification includes risk

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