Ultrasonographic Measurement of Carotid Intima-Medial Thickness as an Assessment of Subclinical Atherosclerosis
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This policy governs the use of B-mode ultrasound measurement of carotid intima-medial thickness for assessment of subclinical atherosclerosis and cardiac risk stratification for Blue Cross and Blue Shield of Kansas members.
No material clinical or coverage changes in this revision.
Coverage Determination and Rationale
General coverage stance
Covered only when meeting established criteria; policy position is:
See Rationale for evidence considerations.
Clinical evidence and impact on coverage
Summary of clinical evidence and coverage-relevant conclusions in this excerpt
No direct evidence that measuring CIMT improves patient outcomes; CIMT progression not predictive of future events in pooled analyses.
Coverage stance and rationale
Coverage determined by insufficient evidence of clinical utility and guideline recommendations
Based on systematic reviews, meta-analyses, lack of direct outcome studies, and guideline recommendations that do not support routine CIMT use.
Ultrasonographic measurement of carotid intima-medial thickness as a technique for identifying subclinical atherosclerosis is considered experimental/investigational for use in the screening, diagnosis, or management of atherosclerotic disease and is not covered outside of research or investigational contexts.
There is no scientific literature that directly tests whether measurement of CIMT improves patient health outcomes. Systematic reviews and meta-analyses report that while CIMT is associated with cardiovascular events, the added predictive value and reclassification into clinically relevant categories are modest and do not demonstrate improved health outcomes when CIMT is used for cardiac risk stratification.
Use of ultrasonographic CIMT measurement is considered experimental/investigational for all diagnoses related to this policy. As such, routine clinical use for diagnostic or therapeutic decision-making is not supported and is subject to noncoverage.
Ultrasonographic measurement of carotid intima-medial thickness is classified as experimental/investigational and therefore not medically necessary for the screening, diagnosis, or management of atherosclerotic disease under this policy.
Although CIMT is associated with future cardiovascular events in observational studies, there is no direct evidence of clinical utility showing that use of CIMT in practice changes management in a way that improves patient outcomes; therefore its role for cardiac risk stratification remains of uncertain benefit.
Major guideline and review bodies do not recommend routine use of CIMT for first-event risk assessment. The 2013 ACC/AHA guidelines give routine CIMT measurement a Class III (no benefit) recommendation, and the USPSTF found the evidence insufficient to assess benefits and harms for screening asymptomatic individuals without CHD.
Procedure and Billing Codes
| Product code: LLZ | FDA product code for devices/software cleared for automatic measurement of carotid IMT |
| 93895 | Quantitative carotid intima media thickness and carotid atheroma evaluation, bilateral |
| none | Experimental/investigational for all diagnoses related to this policy |
Provider Responsibilities and Predetermination
Predetermination available
No review or update is scheduled on this Medical Policy as it is unlikely that further published literature would change the policy position. If there are questions about coverage of this service, please contact Blue Cross and Blue Shield of Kansas customer service, your professional or institutional relations representative, or submit a predetermination request.
- Contact BCBSKS Customer Service for coverage questions
- Professional or institutional relations representative may assist
- Submit a predetermination request when coverage is uncertain
Verify member benefits
Providers should verify member contract benefits at the time of service. Inclusion of a procedure code in this policy does not guarantee coverage; coverage is dependent on the member's contract in effect at the time of service.
- Verify member benefits with BCBSKS Customer Service
- Procedure/diagnosis codes included are informational and do not imply coverage
Services using ultrasonographic measurement
Services utilizing ultrasonographic measurement of carotid intima-media thickness (CIMT) are considered experimental/investigational for screening, diagnosis, or management of atherosclerotic disease. If coverage is unclear for a proposed service involving CIMT or other ultrasonic measurements, submit a predetermination request or contact BCBSKS for guidance.
- Ultrasonographic measurement of carotid intima-media thickness is experimental/investigational
- Submit predetermination if considering CIMT for a member
- Contact BCBSKS Customer Service or professional/institutional relations for coverage questions
Coverage inquiries / predetermination
Providers may contact Blue Cross and Blue Shield of Kansas customer service, their professional or institutional relations representative, or submit a predetermination request for coverage questions or when the applicability of this policy to a specific patient is uncertain.
- BCBSKS Customer Service
- Professional / Institutional Relations representative
- Predetermination submission recommended for coverage clarity
No scheduled review/update
No scheduled review or update is planned for this Medical Policy. For specific coverage questions or if new evidence emerges, providers should contact BCBSKS or submit a predetermination.
- Policy not scheduled for routine review
- Contact BCBSKS or submit predetermination for questions
Background and Scope
Carotid intima-medial thickness (CIMT) measured by B-mode ultrasound quantifies the distance between the lumen‑intima and media‑adventitia interfaces of the carotid artery wall and is used as an imaging surrogate marker of subclinical atherosclerosis. It has been studied as a potential adjunct to traditional risk factors (for example, the Framingham Risk Score) to identify individuals at increased cardiovascular risk, particularly those at intermediate risk; however, evidence of technical reliability and, importantly, that incorporating CIMT into clinical care improves outcomes is lacking.
Key Terms and Definitions
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