CurrentBlue Cross Blue Shield - MassachusettsPolicy 447

Whole‑body Computed Tomography (CT) Screening — Coverage Criteria

This policy governs the use of whole-body computed tomography (CT) scans as a screening test in asymptomatic individuals for Blue Cross Blue Shield - Massachusetts members. It addresses coverage stance, authorization requirements, and coding information for commercial and Medicare products.

Policy Summary

PayerBlue Cross Blue Shield - Massachusetts

PolicyWhole‑body Computed Tomography (CT) Screening — Coverage Criteria

Policy CodePolicy 447

Change TypeClarifiedmaterial statement retainedMedicare content relocated

Effective DateN/A

Next Review DateN/A

Key ActionObtain precertification/preauthorization for inpatient whole‑body CT procedures; outpatient prior authorization depends on product and contract.

SourceLink

POLICY UPDATE CHANGES

Policy statements remain that whole-body CT screening is investigational for asymptomatic individuals.

Clarified coding information.

Medicare information removed; see MP #132 for local and national coverage determinations.

investigationalcoverage stance

inpatient requiredprior auth

no specific codeCPT coding

through 2020

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Coverage Position

Not supported / Investigational

Covered when ALL of the following are met

Investigational stance: Whole-body computed tomography (CT) scans as a screening test in asymptomatic individuals are considered investigational due to lack of evidence demonstrating reduced morbidity or mortality and concerns about high radiation exposure.

Policy concludes investigational; not supported by current literature cited.

Whole-body CT screening performed as a preventive screening test in asymptomatic individuals is considered investigational and is not supported by this policy. This applies to whole-body computed tomography scans that encompass the body from the neck through the pelvis when used as a general screening test in persons without signs or symptoms of disease.

The policy stance reflects the absence of evidence demonstrating reduced morbidity or mortality from whole-body CT screening and concerns about substantial radiation exposure associated with the procedure.

The available literature does not demonstrate that whole-body CT screening improves health outcomes. Evidence reviewed in prior assessments (including a 2003 review and a 2010 report) found no published studies showing reduced morbidity or mortality from using whole-body CT to screen healthy, asymptomatic patients.

Additionally, the radiation exposure from whole-body CT screening is substantial and has been estimated to be 500 to 1,000 times that of a routine chest X-ray; this level of radiation could increase lifetime risk of fatal cancer and is a fundamental concern in deeming the procedure investigational.

Covered Indications

Whole-body CT as general screening in asymptomatic individuals

Screening indication: Asymptomatic individual with no signs or symptoms of disease undergoing whole-body CT screening (CT that encompasses the body from the neck to the pelvis)

This indication is considered investigational per policy.

Coding and Radiation Info

Radiation comparison — whole-body CT vs chest X-ray

Relative radiation magnitudeWhole-body CT screening uses approximately 500 to 1,000 times the radiation of a routine chest X-ray (per cited literature).

Source of comparison2010 report from the Canadian Health Services Research Foundation as cited in policy summary noting the 500–1,000x estimate.

Clinical implicationSubstantially higher radiation exposure contributes to excess lifetime risk of fatal cancer and is a key concern against screening asymptomatic individuals.

Provider Requirements and Authorization

Prior Authorization

Prior Authorization Required

Precertification/preauthorization is required for all products when the procedure is performed inpatient. Lack of the required precertification/preauthorization for inpatient services may result in denial of payment.

Applicable to all products when performed inpatient
Obtain authorization before inpatient admission to avoid denial

Prior Authorization

Outpatient Authorization May Be Product-Dependent

For outpatient procedures, prior authorization requirements vary by product/contract. Providers must check the member's specific product (for example, certain Commercial PPO and Indemnity products) to determine whether outpatient prior authorization is required. If outpatient prior authorization is required by the member's product and is not obtained, claims may be denied.

Outpatient prior authorization depends on product/contract
Verify member benefits and obtain authorization when required

Contrast Use

Billing Rule

Contrast administration — operational documentation

Follow institution and payer guidance on contrast use for CT exams; document contrast administration according to standard operational policies and payer documentation requirements.

Record type and amount of contrast administered in the medical record.
Ensure informed consent and allergy screening are completed per facility protocol.

Definitions

Definition of whole-body CT scan (neck through pelvis) as screening

DefinitionCT scanning that encompasses the body from the neck to the pelvis performed as a general screening test in asymptomatic individuals.

Typical use case describedProposed as a preventive general screening test for detection of diseases such as thyroid and lung cancer in persons without signs or symptoms.

Delivery contextOften marketed directly to patients and offered through mobile CT scanners in community settings (per policy description).

Policy stanceConsidered investigational because evidence does not show reduced morbidity or mortality and because of radiation risk.

Background

Whole-body CT scanning (neck through pelvis) has been proposed as a preventive screening measure in asymptomatic individuals to detect diseases such as thyroid and lung cancer. These services are sometimes offered directly to consumers, including via mobile CT units.

Despite interest in whole-body CT as a screening tool, reviews of the evidence have not shown a benefit in life expectancy or reduced disease-specific morbidity or mortality, and the high radiation dose associated with whole-body CT raises concerns about potential excess lifetime cancer risk.

Not Covered

Whole-body CT screening (neck through pelvis) for asymptomatic individuals (screening indication) is not covered because it is considered investigational.

Requests for whole-body CT performed for screening of healthy, asymptomatic persons are subject to denial on the basis that the procedure lacks evidence of improved health outcomes and carries substantial radiation risk.