Quick answer
CPT 75574 is coronary CT angiography: CT of the heart, coronary arteries and bypass grafts with contrast, including image post-processing and quantitative evaluation of coronary calcium when performed. Most denials are coverage and documentation failures, not coding errors.
- Because 75574 already includes calcium evaluation when performed, 75571 is not separately reported for the same study.
- 75572 (cardiac structure and morphology) and 75573 (congenital heart disease) describe different studies; they are not interchangeable with 75574.
- Modifier 26 reports the professional component and modifier TC the technical component. Billing globally when you own only one component invites a recoupment.
Coronary CT angiography is a high-value study with an unusually narrow coverage envelope. When a 75574 claim denies, the cause is rarely that someone picked the wrong five digits; it is almost always that the payer was not persuaded the study was indicated, or that the claim did not reflect who actually owned the equipment and the read. Here are the drivers we see most often, and what to do about each.
What 75574 actually covers
- 75574: CT angiography, heart, coronary arteries and bypass grafts (when present), with contrast material, including 3D image post-processing and quantitative evaluation of coronary calcium when performed.
- 75571: CT of the heart without contrast, with quantitative evaluation of coronary calcium. This is the standalone calcium score.
- 75572: CT of the heart with contrast, for evaluation of cardiac structure and morphology.
- 75573: CT of the heart with contrast, for evaluation of cardiac structure and morphology in congenital heart disease.
The single most important structural point: the calcium evaluation is inside the 75574 descriptor. Adding 75571 for the same study is duplicate reporting.
Denial driver 1: no documented indication on the order
Payer coverage policies for CCTA are indication-driven. Typical covered scenarios include evaluation of stable or acute chest pain in a patient at low-to-intermediate risk of coronary artery disease, equivocal or non-diagnostic results from a prior functional study, and assessment of anomalous coronary anatomy. A screening study on an asymptomatic patient is generally not covered.
The fix: the order must carry the clinical question, not just the study name. “CCTA” on its own is not an indication. “Atypical chest pain, intermediate pre-test probability, equivocal stress test on [date]” is.
Denial driver 2: prior authorization not obtained
Advanced cardiac imaging sits inside most commercial radiology benefit-management programmes. Authorisation is usually tied to the specific CPT code and to a date window, and the review often asks for the prior functional study result before it will approve.
The fix: build the authorisation request around the same evidence the payer will ask for: symptoms, risk factors, prior testing and its result. Re-verify the window whenever the study is rescheduled.
Denial driver 3: unbundling the calcium score
This is the most common pure-coding error on the study. A CCTA performed with calcium quantification is one code: 75574. Reporting 75571 alongside it will trigger a bundling denial, and where it slips through it is a recoupment risk on audit.
The fix: a pre-bill edit that blocks 75571 and 75574 on the same date of service for the same patient unless a coder overrides it with a documented reason.
Denial driver 4: professional and technical components mismatched
The rules are simple and the operational discipline is not. If the practice owns the scanner and reads the study, bill globally. If the practice owns the scanner and an outside radiologist reads, the practice bills 75574-TC and the radiologist bills 75574-26. If the study is performed at a facility and the practice only reads, the practice bills 75574-26.
Practices that bill globally when a separate reader is also billing the professional component usually get paid first and clawed back later, once both claims land with the same payer.
The fix: lock the modifier into the order set by site of service, and confirm at onboarding whether reads are in-house or outsourced.
Denial driver 5: the report does not support the code
The descriptor includes 3D image post-processing. A reviewer expects the report to reflect that work: reconstructions performed, coronary segments assessed, image quality, and where calcium quantification was performed, the score itself. A brief narrative that reads like a chest CT report will not support a CCTA charge on a records request.
The fix: a structured CCTA report template with named fields for segment-level findings, image quality, and the calcium score where obtained.
Denial driver 6: diagnosis coding that undercuts the indication
A claim that carries a definitive coronary artery disease diagnosis can read as a study performed on an already-diagnosed patient, which some policies exclude. Conversely, a vague symptom code with no risk context may not clear the medical-necessity threshold. The diagnosis should reflect the clinical question at the time the study was ordered.
The fix: code from the order and the pre-test clinical picture, not from the CCTA result.
Two adjunct codes many charge masters are missing
75574 is no longer the only cardiac CT angiography code a cardiology practice needs to know. 75580 (noninvasive estimated coronary fractional flow reserve derived from coronary CT angiography data) moved from Category III to Category I effective 1 January 2024. 75577 (quantification of coronary atherosclerotic plaque from CT angiography data) took effect 1 January 2026, replacing the Category III codes 0623T, 0624T, 0625T and 0626T, which were deleted the same day.
The practical risk is a charge master that was never updated: a 2026 date of service submitted with 0623T, 0624T, 0625T or 0626T will reject on receipt. Confirm each payer’s reporting rules for 75577 and 75580 before you build charge-capture edits around them.
Documentation checklist
- Order stating the clinical question, symptoms and pre-test risk.
- Prior functional or anatomic testing and its result, where one exists.
- Prior authorization number, the code it covers and its date range.
- Contrast administered, documented.
- Structured report with segment-level findings and image quality.
- Calcium score recorded where quantification was performed, and 75571 not separately billed.
- Component ownership confirmed, with modifier 26 or TC applied to match.
- ICD-10 selected from the pre-test clinical picture.
Free 2026 Cardiology CPT Cheat Sheet
Cardiac CT and the rest of the cardiology code set on one printable page: 75574, 75571, 75572, 75573, the 26/TC split, and the modifiers that most often trigger denials.
Get the free cheat sheet →If your CCTA line is denying and you cannot tell whether it is coverage, components or documentation, we will pull a sample and show you. Talk to AMS Solutions: medical billing and revenue cycle management since 1992.
