CurrentBlue Cross Blue Shield - Rhode IslandPolicy N/A

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

Defines Blue Cross Blue Shield - Rhode Island coverage stance for ultrasonic measurement of carotid intima-media thickness (CIMT) to identify subclinical atherosclerosis for Medicare Advantage and commercial products, including coding and rationale. Notes that benefits may vary by contract.

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

PolicyMeasurement of Carotid Intima-Medial Thickness as an Assessment of Subclinical Artherosclerosis

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateN/A

Key ActionVerify member-specific benefits and contract exclusions; refer to Evidence of Coverage/Subscriber Agreement as coverage may vary by group or contract.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes — policy remains unchanged.

1Specific CPT code listed as not medically necessary

Medicare & CommercialPayer populations addressed

Coverage Summary

This policy defines Blue Cross Blue Shield - Rhode Island coverage for ultrasonographic measurement of carotid intima-media thickness (CIMT) for Medicare Advantage and commercial products.

For Commercial products: CIMT is not medically necessary / not covered for screening, diagnosis, or management of atherosclerotic disease for the same reason; benefits may vary by group or contract so refer to the Evidence of Coverage/Subscriber Agreement.

Key stats and thresholds

Specific CPT code listed as not medically necessary1

Listed CPT code93895

Payer populations addressedMedicare & Commercial

Coverage stance summaryNot covered / not medically necessary for screening, diagnosis, or management of atherosclerotic disease

Advice on benefits variabilityBenefits may vary by group and contract; refer to Evidence of Coverage/Subscriber Agreement

Medical-Necessity Determination

Coverage determination

Ultrasonographic measurement of carotid artery intima-medial thickness (CIMT) as a technique of identifying subclinical atherosclerosis is:

ALL of the following

Medicare Advantage Plans: For Medicare Advantage Plans: CIMT is not covered for use in the screening, diagnosis, or management of atherosclerotic disease because evidence is insufficient to determine effects on health outcomes.
Commercial Products: For Commercial Products: CIMT is not medically necessary for use in the screening, diagnosis, or management of atherosclerotic disease because evidence is insufficient to determine effects on health outcomes.
Benefits-vary: Benefits may vary between groups and contracts; refer to Evidence of Coverage/Subscriber Agreement for member-specific coverage.

Provider Actions

Documentation Required

Benefit verification

Verify member-specific benefits and contract exclusions; refer to Evidence of Coverage/Subscriber Agreement as coverage may vary by group or contract.

Evidence of Coverage/Subscriber Agreement

Denial Risk

Service not covered

Claims for CIMT (e.g., CPT 93895) are considered not medically necessary / not covered for screening, diagnosis, or management of atherosclerotic disease and may be denied.

93895

Background & Evidence

Carotid intima-media thickness (CIMT) is a B-mode ultrasound measurement of the combined thickness of the intima and media layers of the carotid artery wall, typically averaged over multiple sites, proposed as a surrogate marker for atherosclerosis and cardiovascular risk. Systematic reviews and cohort studies demonstrate associations between increased CIMT and future cardiovascular events, but available evidence is insufficient to show that measuring CIMT improves patient outcomes, provides clear added predictive value in clinical practice, or defines how CIMT measurements should change management.

Evidence summary

Carotid intima-media thickness (CIMT): Ultrasonographic measurement of the combined thickness of the intima and media layers of the carotid artery wall using B-mode ultrasound, typically averaged over multiple sites.