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Anthem BCBS (Carelon) — CT Angiography (CTA)

This page shows prior authorization criteria extracted from Anthem BCBS (Carelon)'s published imaging guidelines. 40 matching coverage rules found for this procedure.

Coverage Rules from Anthem BCBS (Carelon) Policy

Aneurysm of the abdominal aorta or iliac arteries

Indication Code: CARELON-VAS-029

Aneurysm, extracranial (carotid or vertebral)

Indication Code: CARELON-VAS-009

Aneurysm, intracranial

Indication Code: CARELON-VAS-008

Aortic dissection and other aortopathies

Indication Code: CARELON-VAS-022

Aortic dissection and other aortopathies

Indication Code: CARELON-VAS-028

Arteriovenous malformation (AVM) or fistula (AVF)

Indication Code: CARELON-VAS-010

Arteriovenous malformation (AVM) or fistula (AVF)

Indication Code: CARELON-VAS-030

Atheromatous disease (Adult only)

Indication Code: CARELON-VAS-024

Congenital or developmental vascular anomalies, not otherwise specified

Indication Code: CARELON-VAS-001

Dissection, intracranial or extracranial

Indication Code: CARELON-VAS-011

Established flow-limiting CAD in patients who have new or worsening symptoms

Indication Code: CARELON-HEA-013

Established or suspected CAD

Indication Code: CARELON-HEA-014

Evaluation for suspected vascular complications following a procedure

Indication Code: CARELON-VAS-007

Fibromuscular dysplasia

Indication Code: CARELON-VAS-012

Hematoma/hemorrhage within the abdomen or pelvis

Indication Code: CARELON-VAS-031

Hemorrhage, intracranial

Indication Code: CARELON-VAS-013

Horner’s syndrome

Indication Code: CARELON-VAS-014

Mesenteric ischemia or mesenteric stenosis/occlusion

Indication Code: CARELON-VAS-032

Miscellaneous indications for CCTA

Indication Code: CARELON-HEA-015

Other vascular indications in the chest

Indication Code: CARELON-VAS-027

Portal hypertension

Indication Code: CARELON-VAS-033

Procedure related imaging of the intracranial vessels

Indication Code: CARELON-VAS-016

Pulmonary embolism

Indication Code: CARELON-VAS-026

Pulmonary hypertension

Indication Code: CARELON-VAS-025

Pulsatile tinnitus

Indication Code: CARELON-VAS-015

Renal artery stenosis (RAS)/Renovascular hypertension

Indication Code: CARELON-VAS-034

Signs, symptoms, and abnormal imaging (including stroke or transient ischemic attack (TIA))

Indication Code: CARELON-VAS-017

Stenosis or occlusion of the abdominal aorta or iliac arteries (aortoiliac peripheral arterial disease)

Indication Code: CARELON-VAS-035

Stenosis or occlusion of the carotid and vertebrobasilar arteries without symptoms

Indication Code: CARELON-VAS-018

Suspected CAD in symptomatic patients who have not had evaluation for CAD within the preceding 60 days

Indication Code: CARELON-HEA-012

Thoracic aortic aneurysm

Indication Code: CARELON-VAS-023

Traumatic vascular injury

Indication Code: CARELON-VAS-002

Trigeminal neuralgia

Indication Code: CARELON-VAS-019

Vascular anatomic delineation prior to surgical and interventional procedures, not otherwise specified*

Indication Code: CARELON-VAS-006

Vascular evaluation prior to transcatheter aortic valve implantation/replacement (TAVI/TAVR) or cardiac surgery

Indication Code: CARELON-VAS-005

Vasculitis

Indication Code: CARELON-VAS-003

Venous Indications

Indication Code: CARELON-VAS-036

Venous thrombosis or compression, extracranial

Indication Code: CARELON-VAS-021

Venous thrombosis or compression, intracranial

Indication Code: CARELON-VAS-020

Visceral artery aneurysm

Indication Code: CARELON-VAS-037

How to Submit a Prior Authorization Request

Submit via: Anthem Provider Portal or Carelon Medical Benefits Management (formerly AIM) at 1-800-252-2021

📄 Required Documentation Checklist

  • Patient demographics and insurance information
  • Ordering provider NPI and contact information
  • Specific clinical indication with ICD-10 diagnosis code(s)
  • Relevant clinical history and physical exam findings
  • Results of prior conservative treatment (if applicable)
  • Prior imaging results relevant to the indication
  • Supporting lab or diagnostic results where applicable

⏱ Turnaround Times

Standard prior authorization requests are typically processed within 3–5 business days. Urgent/expedited requests may be processed within 24–72 hours when clinically necessary.

📣 Appeal Window

Most plans allow 30–60 days to file a first-level appeal. Expedited appeals for urgent cases are typically processed within 72 hours.

⚠ Common Denial Reasons

  • Insufficient clinical documentation to establish medical necessity
  • Clinical criteria not met per payer guidelines
  • Lack of documented prior conservative treatment
  • Missing required prior imaging as step therapy
  • Incorrect or unsupported ICD-10 diagnosis code pairing
  • Request submitted outside of authorization timeframe

⚠ This study uses ionizing radiation. Payers may ask that non-ionizing alternatives (MRI, ultrasound) be considered first when clinically appropriate.

Clinical Approval Criteria

✓ Generally Approved When:

  • Acute vascular emergency: no prior auth required
  • Elective: document clinical indication, prior non-invasive testing results
  • Coronary CTA: document intermediate pre-test probability for CAD, typical symptom profile
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Disclaimer: Coverage criteria shown on this page are sourced from publicly available payer guidelines and are provided for informational and educational purposes only. Prior authorization requirements change frequently. Always verify current criteria directly with the payer or their delegated utilization management company before submitting an authorization request. This page does not constitute medical or legal advice.