CurrentBlue Cross Blue Shield - Rhode IslandPolicy N/A

Measurement of Carotid Intima‑Medial Thickness (CIMT)

This policy governs use of B‑mode ultrasonographic measurement of carotid intima‑media thickness (CIMT) for screening, diagnosis, or management of atherosclerotic disease for Blue Cross Blue Shield - Rhode Island members.

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

PolicyMeasurement of Carotid Intima‑Medial Thickness (CIMT)

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateN/A

Next Review DateN/A

Key ActionDo not bill for CIMT (CPT 93895) for screening, diagnosis, or management of atherosclerotic disease because it is considered not medically necessary.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

Not coveredCoverage stance

93895Code listed

Sep 2024Most recent update

UncertainEvidence certainty

Coverage Criteria — Carotid Intima‑Media Thickness (CIMT)

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Not covered — CIMT for screening, diagnosis, or management

Covered when ALL of the following are met:

Policy coverage decision: Ultrasonographic measurement of carotid artery intima‑medial thickness (CIMT) for identification of subclinical atherosclerosis is not covered for use in the screening, diagnosis, or management of atherosclerotic disease because the evidence is insufficient to determine effects on health outcomes.

Systematic reviews and cohort studies show associations between increased CIMT and future cardiovascular events, but there is no direct evidence that measuring CIMT improves patient outcomes or provides clear guidance for risk management.

Ultrasonographic measurement of carotid artery intima‑medial thickness (CIMT) is not covered when used to identify subclinical atherosclerosis for the screening, diagnosis, or management of atherosclerotic disease because the evidence is insufficient to determine effects on health outcomes.

Benefits and coverage for members are determined by the member's Evidence of Coverage, Subscriber Agreement, or employer agreement; those documents supersede this policy. The policy excerpt does not list additional clinical exceptions within the text provided.

For commercial products, CIMT is considered not medically necessary for use in the screening, diagnosis, or management of atherosclerotic disease. CPT code 93895 (Quantitative carotid intima media thickness and carotid atheroma evaluation, bilateral) is listed as not medically necessary.

Services determined to be not medically necessary, or medically necessary services that are non‑covered benefits, may not be covered. Providers may not charge the member for such services unless the member has been informed and has provided prior written agreement to accept financial responsibility.

Provider Actions / Billing Guidance

Prior Authorization

Prior authorization / Benefit verification

No prior authorization required for carotid intima-media thickness (CIMT). Coverage may vary by contract — verify benefits in the member's Evidence of Coverage or Subscriber Agreement.

Verify benefits and eligibility with the member's Evidence of Coverage or Subscriber Agreement before scheduling.
Contact the provider call center for member-specific benefits and eligibility questions.
If a service is determined to be not medically necessary or is a non-covered benefit, do not bill the member unless you have provided advance written notice and the member agreed to self-pay.

Denial Risk

Denial risk for CIMT

Claims for carotid intima-media thickness (CIMT), including CPT 93895, are considered not medically necessary when billed for screening, diagnosis, or management of atherosclerotic disease and are subject to denial.

CPT 93895 — Quantitative carotid intima media thickness and carotid atheroma evaluation, bilateral — Not medically necessary / subject to denial

Documentation Required

Provider responsibilities / Member billing

This policy is informational and not a guarantee of payment. Benefits and eligibility are determined by the member's subscriber agreement or employer agreement; those documents supersede this policy.

Provide members with notice and obtain written agreement before billing for non-covered services when applicable.
BCBSRI may review and revise this policy at any time.

Background

Carotid intima‑media thickness (CIMT) uses B‑mode ultrasound to measure the combined thickness of the intima and media layers of the carotid arterial wall as a surrogate marker for atherosclerosis. It has been evaluated to detect and monitor subclinical atherosclerosis and to help stratify cardiovascular risk, though evidence is insufficient to demonstrate improved clinical outcomes.

Definitions

Carotid Intima‑Media Thickness (CIMT)

DefinitionUltrasonographic measurement (B-mode) of the combined intima and media layers of the carotid artery wall; the distance between the two echogenic lines (intima–lumen and media–adventitia interfaces) is measured and typically averaged over multiple sites.

Typical measurement approachB-mode ultrasound imaging of carotid arteries with far‑wall imaging of each common carotid artery; measurements are averaged over several sites to improve reproducibility.

Clinical intentUsed to detect and monitor intima–media thickening as a surrogate marker for atherosclerosis and to assess subclinical vascular disease and cardiovascular risk stratification.

Carotid IMT / carotid plaque assessment (per professional society guidance)

Term as used in guidelinesCarotid IMT and carotid arterial plaque assessment are referenced by professional society guidelines and consensus statements for identification of subclinical vascular disease.

Representative guideline endorsementsConsensus statements and guideline documents (e.g., American Society of Echocardiography task force and ACC/AHA guideline reports) reference CIMT and carotid plaque assessment for cardiovascular risk evaluation.

Scope of assessmentIncludes both quantitative IMT measurement and evaluation/characterization of carotid arterial plaque when assessing atherosclerosis and cardiovascular risk.