Ischemic heart disease remains the leading cause of death globally, making accurate and noninvasive diagnostic tools crucial for effective management. Coronary computed tomography angiography (CCTA) has proven invaluable for screening patients with low to moderate pretest probability of coronary artery disease (CAD), with high accuracy and negative predictive value. However, the integration of computed tomography-derived fractional flow reserve (CT FFR) has significantly enhanced CCTA’s role by not only assessing the presence of disease but also improving specificity for identifying hemodynamically significant stenoses. CT FFR, a noninvasive imaging modality, simulates invasive FFR measurement by modeling coronary blood flow dynamics, thus offering a more precise evaluation of CAD and guiding decisions on revascularization. Key technical considerations for CT FFR include standardized imaging protocols, such as optimal scan parameters, ECG-triggered acquisitions, and the use of pharmacologic agents. The CAD-RADS classification system, which quantifies coronary stenosis severity, now incorporates CT FFR, further refining its clinical utility. CT FFR is particularly useful in managing patients with moderate stenosis (50–69%) or severe stenosis (70–99%), helping to guide treatment decisions, including whether to proceed with invasive coronary angiography (ICA) or revascularization. While CT FFR has shown promise in assessing ischemia and guiding interventions, challenges such as borderline values, discordance between CTA and CT FFR, and diffuse coronary disease remain. Despite these challenges, CT FFR remains a highly valuable tool in the diagnosis and management of CAD, offering a noninvasive alternative to traditional invasive techniques. Continued research and advancements in CT FFR technology are essential to optimize its clinical impact and address existing limitations.