Which payers have published criteria for CT heart for congenital heart disease (CPT 75573)?

The imaging guidelines used by Aetna, Anthem BCBS, Cigna, Medicare, UnitedHealthcare include criteria that apply to this study. Whether a specific patient's plan requires prior authorization depends on the plan, so confirm on the payer's portal or by phone before scheduling.

Who reviews prior authorization requests for CT heart for congenital heart disease (CPT 75573)?

Most commercial payers hand imaging reviews to a radiology benefit manager. For the payers tracked here, requests are reviewed using guidelines from eviCore, Carelon, CMS, UnitedHealthcare / eviCore. The request is submitted through that organization's portal rather than the health plan's general line.

What should be in the clinical notes before requesting CT heart for congenital heart disease (CPT 75573)?

Reviewers look for a recent office visit that documents the symptoms and how long they have lasted, exam findings, results of any earlier imaging, treatments already tried and how the patient responded, and the specific question the study is expected to answer. The diagnosis code on the request should match what the notes describe.

How much does CT heart for congenital heart disease (CPT 75573) cost?

Across 639 hospitals that publish their negotiated rates, the median commercial insurance rate is $635, with the middle half of rates between $362 and $1,390. A patient's own cost depends on their plan, deductible and where the study is done.

What can be done if CT heart for congenital heart disease (CPT 75573) is denied?

Read the denial letter for the stated reason, then request a peer-to-peer conversation between the ordering clinician and the reviewing physician, which often resolves missing-information denials. If that fails, file a written appeal that answers the stated reason directly and attach the supporting notes. The denial letter lists the deadline and where to send the appeal.

CPT 75573: CT heart for congenital heart disease - Prior Authorization and Price

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CPT 75573

Reviewing a CT scan of the heart related to congenital heart disease that uses contrast.

CT Heart

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Payer guidelines that apply

Payer	Reviewed using	Guideline	Sections
Aetna	eviCore	Pediatric Cardiac Imaging Guidelines effective Feb 3, 2026 Cardiac Imaging Guidelines 2.0.2026, effective Sep 1, 2026	5 that name this code
Anthem BCBS	Carelon	Imaging of the heart effective Nov 15, 2025	2 that name this code
Cigna	eviCore	Pediatric Cardiac Imaging Guidelines 1.0.2026, effective Feb 3, 2026 Cardiac Imaging Guidelines 2.0.2026, effective Sep 1, 2026	5 that name this code
Medicare	CMS	NCD 220.1: Computed Tomography effective Mar 12, 2008 L33559: Cardiac Computed Tomography (CCT) and Coronary Computed Tomography Angiography (CCTA) (Wellpoint Federal) effective Apr 1, 2026 L33947: Cardiac Computed Tomography (CCT) and Coronary Computed Tomography Angiography (CCTA) (CGS Administrators) effective Oct 9, 2025 L33423: Cardiac Computed Tomography & Angiography (CCTA) (Palmetto GBA) effective Jun 26, 2025	4 that name this code
Original Medicare does not run a prior authorization program for outpatient imaging; claims are judged against the coverage policies above. Medicare Advantage plans set their own prior authorization rules.
UnitedHealthcare	UnitedHealthcare / eviCore	Commercial and Exchange Cardiovascular and Radiology Imaging Guidelines 09.2026, effective Sep 1, 2026	5 that name this code

Guidelines collected from the payers' published documents on September 29, 2026. Payers revise these documents during the year. Open the guideline link to confirm the current version before you submit.

Conditions the guidelines address for this study

These are the clinical situations where payer guidelines discuss CT heart for congenital heart disease. Each has its own criteria for when the study is considered appropriate.

Cardiac Computed Tomography (CCT) and Coronary Computed Tomography Angiography (CCTA) Medicare
Cardiac Computed Tomography & Angiography (CCTA) Medicare
Computed Tomography Medicare
Congenital heart disease Anthem BCBS
Indications for FFR-CT Anthem BCBS

Typical price

Commercial insurance, median

$635

Middle half of rates: $362 to $1,390

Medicare, hospital outpatient

$356

Facility payment

Medicare, physician fee schedule

$311

National, non-facility

Commercial figures come from negotiated rates published by 639 hospitals; Medicare figures from CMS fee schedules. Rates vary widely by hospital and plan. Pricing data from CenterIQ.

Get notified when the rules for this study change

Payers update imaging guidelines several times a year. We will email you when the criteria for CT heart for congenital heart disease change.

CPT 75573: CT heart for congenital heart disease - Prior Authorization and Price

Payer guidelines that apply

Conditions the guidelines address for this study

Typical price

Get notified when the rules for this study change

Frequently asked questions

Imaging CPT Code Coverage Lookup

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CPT 75573: CT heart for congenital heart disease - Prior Authorization and Price

Payer guidelines that apply

Conditions the guidelines address for this study

Typical price

Get notified when the rules for this study change

Frequently asked questions

Related studies

Imaging CPT Code Coverage Lookup

Quick Access - Common Imaging CPT Codes

CT

MRI

MRA

PET