CurrentBlue Cross Blue Shield - Rhode IslandPolicy N/A

Ultrasonographic Measurement of Carotid Intima-Medial Thickness as an Assessment of Subclinical Artherosclerosis

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

PolicyUltrasonographic Measurement of Carotid Intima-Medial Thickness as an Assessment of Subclinical Artherosclerosis

Policy CodePolicy N/A

Change TypeNo material change

Effective DateOct 1, 2015

Next Review Date

Key ActionClaims for CPT 93895 are not medically necessary / not covered and may be denied.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes reported for this update.

1Not covered CPT codes listed

CURRENTPolicy status

Coverage Summary & Determination

Defines coverage stance for B-mode ultrasound measurement of carotid intima-media thickness (CIMT) for detection/monitoring of subclinical atherosclerosis for Medicare Advantage and Commercial products offered by Blue Cross Blue Shield Rhode Island. Coverage stance: not covered / not medically necessary (evidence judged insufficient to determine effects on health outcomes). Key evidence statement: Evidence is insufficient to determine the effects of CIMT on health outcomes for screening, diagnosis, or management of atherosclerotic disease. Effective date: 2015-10-01; Policy last reviewed: 2023-06-22.

Coverage Determination

Policy statements for Medicare Advantage Plans and Commercial Products:

ALL of the following

Medicare Advantage Plans: Ultrasonographic measurement of carotid artery intima-medial thickness (CIMT) as a technique of identifying subclinical atherosclerosis is not covered for use in the screening, diagnosis, or management of atherosclerotic disease (evidence insufficient to determine the effects of the technology on health outcomes).
Commercial Products: Ultrasonographic measurement of carotid artery intima-medial thickness (CIMT) is not medically necessary for use in the screening, diagnosis, or management of atherosclerotic disease (evidence insufficient to determine the effects of the technology on health outcomes).

Provider Actions & Billing Impact

Documentation Required

Prior authorization

Prior authorization: Not applicable (no prior authorization requirement specified).

Denial Risk

Claim denial risk for CIMT (CPT 93895)

Claims for quantitative carotid intima-media thickness and carotid atheroma evaluation (CPT 93895) are not medically necessary / not covered and may be denied.

93895

Background and Definitions

CIMT uses B-mode ultrasound to measure the thickness of the intima and media layers of the carotid artery as a surrogate marker for atherosclerosis. It has been investigated to identify and monitor subclinical atherosclerosis and potentially improve risk stratification, but the available evidence is judged insufficient to determine the effects of CIMT on health outcomes for screening, diagnosis, or management of atherosclerotic disease.

Definitions

Key Dates