Most insurance plans do not cover coronary calcium scans as a routine screening test. Medicare explicitly denies coverage, calling it “not medically necessary” when performed in isolation. Private insurers vary, with some covering the scan only when specific risk criteria are met. The good news: out-of-pocket costs are relatively low, typically ranging from $75 to $200.
Why Most Plans Consider It a Screening Test
A coronary calcium scan (also called a CAC score) uses a quick, low-dose CT scan to measure calcium buildup in your coronary arteries. Higher calcium means more plaque, which signals greater heart attack risk. But because the test is used to assess risk in people who don’t yet have symptoms, insurers classify it as a screening service rather than a diagnostic one. That distinction matters because screening tests face a higher bar for coverage.
The U.S. Preventive Services Task Force, the federal body whose recommendations determine which preventive screenings insurers must cover at no cost under the Affordable Care Act, has not given coronary calcium scoring a favorable rating. Its current assessment dates to 2018, and an update is in progress as of late 2024, but until the task force issues a positive recommendation, there is no federal mandate requiring coverage.
Medicare Does Not Cover It
Medicare’s position is straightforward. The Centers for Medicare and Medicaid Services classifies the calcium scoring procedure (billed under CPT code 75571) as not medically necessary and denies claims for it. Even when a calcium score is performed alongside a CT angiogram, Medicare does not reimburse it separately. If you’re on Medicare and want a calcium score, you’ll pay the full cost yourself.
Private Insurance Coverage Varies Widely
Some private insurers will cover a coronary calcium scan, but only if you meet specific medical criteria. Aetna, for example, considers the test medically necessary in two main situations: for people age 40 and older who have diabetes but no symptoms, and for people with an intermediate 10-year risk of a cardiac event (between 10% and 20%) based on standard risk calculators like the Pooled Cohort Equations. If your doctor has already calculated your risk score and it falls in that intermediate zone, you have a stronger case for coverage.
Aetna also covers repeat calcium scoring, but only if your previous score was zero, at least five years have passed since your last scan, and finding calcium would actually change your treatment plan. Other major insurers like UnitedHealthcare and Cigna have their own criteria, and policies can differ between plan types within the same company. Your best move is to call the number on the back of your insurance card before scheduling the scan and ask whether it’s covered under your specific plan.
If your insurer does cover the test, how your doctor orders it matters. A scan ordered as “screening” is more likely to be denied than one ordered with a specific clinical rationale tied to your risk profile. Your doctor’s office can help ensure the claim is submitted with the right documentation.
A Few States Require Coverage
Texas is the only state that has passed a law mandating insurance coverage for coronary calcium scoring. The law (HB 1290) requires reimbursement of up to $200 for the test in men ages 45 to 75 and women ages 55 to 75 who fall into the intermediate risk category. Florida and South Carolina have introduced similar bills, but neither had passed into law at the time of the most recent legislative sessions. If you live in Texas and meet the age and risk criteria, your insurer is required to help pay for the scan.
Out-of-Pocket Costs Are Lower Than You Might Expect
Compared to most imaging tests, a coronary calcium scan is inexpensive. Johns Hopkins, for instance, offers the scan at a self-pay rate of $125. Prices at other facilities typically fall between $75 and $200 depending on your location. Freestanding imaging centers tend to charge less than hospital-based radiology departments.
Many facilities offer a direct self-pay option that bypasses insurance entirely. This can actually simplify the process: no prior authorization, no surprise denials, and in some cases a lower price than what you’d pay after your insurer’s “negotiated rate” is applied to your deductible. When you schedule, ask the facility for their cash price and compare it to what you’d owe through insurance.
How to Improve Your Chances of Coverage
If you want to try getting your insurer to pay, a few steps can help. First, ask your doctor to calculate your 10-year cardiovascular risk score. If it falls between 10% and 20%, you’re in the intermediate-risk group that most coverage policies target. Second, make sure the order includes a clinical justification, not just “screening.” Third, request prior authorization before the scan rather than submitting a claim afterward and hoping for the best.
If your claim is denied, you can appeal. Include a letter from your doctor explaining why the test is clinically appropriate for your specific situation. Some patients have successfully overturned denials this way, particularly when their risk profile clearly matches the insurer’s own medical necessity criteria. That said, given the low out-of-pocket cost, many people find it simpler to pay cash and skip the insurance process altogether.