CurrentBlue Cross Blue Shield - Rhode IslandPolicy N/A

Ultrasonographic Measurement of Carotid Intima-Medial Thickness (CIMT) as an Assessment of Subclinical Atherosclerosis

This policy states the coverage stance for use of B-mode ultrasonographic measurement of carotid intima-media thickness (CIMT) to identify or monitor subclinical atherosclerosis for Blue Cross Blue Shield - Rhode Island members.

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

PolicyUltrasonographic Measurement of Carotid Intima-Medial Thickness (CIMT)

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateOct 1, 2015

Next Review DateN/A

Key ActionVerify member benefits and eligibility with the provider call center before billing, since coverage may vary by contract.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

93895CPT code listed as not medically necessary

Not medically necessaryCoverage determination for CIMT

FDA 510(k)FDA clearance noted

30+Literature references

Coverage Criteria

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Overall coverage stance

Covered when ALL of the following are met

ALL of the following

Ultrasonographic measurement of carotid intima‑media thickness (CIMT) is requested.
Intended use is for identification, screening, diagnosis, or management of atherosclerotic disease.
Evidence demonstrates improved health outcomes for the proposed use.

ALL of the following

Policy position: Ultrasonographic measurement of CIMT for identifying subclinical atherosclerosis is not covered for screening, diagnosis, or management (not medically necessary).

Ultrasonographic measurement of carotid intima-media thickness (CIMT) for the identification, screening, diagnosis, or management of subclinical atherosclerosis is not covered / considered not medically necessary. The evidence is insufficient to demonstrate that CIMT improves health outcomes for these uses.

Coverage and payment are governed by the member's Evidence of Coverage, Subscriber Agreement, or employer agreement which supersede this policy. For member-specific benefits or eligibility questions, contact the provider call center. Providers should not bill members for services determined to be not medically necessary unless the member was informed and agreed in writing in advance to accept financial responsibility.

Carotid intima-media thickness testing, including procedures reported with CPT code 93895, is considered not medically necessary for screening, diagnosis, or management of atherosclerotic disease and therefore is not covered.

Provider Actions & Billing Guidance

Prior Authorization

Prior authorization is not applicable for this policy.

Note

Verify Benefits / Authorization

Verify member benefits and any authorization requirements prior to scheduling services. Contact the provider call center for member-specific benefit, eligibility, and prior authorization information.

Contact provider call center for member-specific benefits and authorization requirements
Benefits and eligibility determined by the member's Evidence of Coverage / Subscriber Agreement

Step Therapy

Step Therapy / Medical Criteria

No step therapy requirements or medical-necessity criteria are specified for this service.

Documentation Required

Benefit Verification

Benefits and coverage may vary by contract. Refer to the member's Evidence of Coverage or Subscriber Agreement to determine whether this service is covered under the member's plan.

Refer to Evidence of Coverage / Subscriber Agreement for contract-specific benefit details

Denial Risk

Denial Risk for CIMT

Claims for carotid artery intima-media thickness (CIMT) measurement (including CPT 93895) for screening, diagnosis, or management of atherosclerotic disease are considered not medically necessary and may be denied.

93895 — Quantitative carotid intima media thickness and carotid atheroma evaluation; bilateral — Not medically necessary

Billing Rule

Billing and Payment Risk

If services are determined to be not medically necessary or are non-covered benefits, claims may not be paid and the provider may be financially liable. Inform members in writing before providing non-covered services if they will be charged directly.

Non-medically necessary services may result in nonpayment and provider liability
Obtain written agreement from member before providing and charging for non-covered services

Note

Provider Action

(Provider action) For member-specific questions or to confirm coverage, contact the provider call center.

Use the provider call center for case-specific inquiries

Background

Carotid intima-media thickness (CIMT) is the combined thickness of the intima and media layers of the carotid artery measured by B‑mode ultrasound and has been evaluated as a surrogate marker for atherosclerosis. Although ultrasound—particularly far‑wall common carotid imaging—can provide reproducible measurements, available evidence does not demonstrate that use of CIMT for population screening, diagnosis, or management leads to improved clinical health outcomes; therefore its routine clinical use for these purposes is not supported by this policy.

Definitions

Carotid intima-media thickness (CIMT) — definition and measurement

TermCarotid intima-media thickness (CIMT)

DefinitionThe distance between the lumen–intima interface and the media–adventitia interface measured by B‑mode ultrasound, representing combined thickness of the intima and media layers of the carotid artery wall.

Measurement approachTypically measured with B‑mode ultrasound and averaged over several sites in each carotid artery; far‑wall common carotid imaging yields more accurate and reproducible measurements than near‑wall imaging.

Anatomic layers measuredIntima and media (the two innermost layers of the carotid artery wall).

Physiologic intentUsed as a surrogate marker for atherosclerosis to detect or monitor intima‑media thickening and subclinical atherogenic disease progression.

Carotid ultrasound/CIMT — clinical use and guideline context

UseCarotid ultrasound/CIMT is used to identify and monitor subclinical vascular disease as a surrogate marker for atherosclerosis.

ModalityB‑mode ultrasound of the carotid arteries, measuring CIMT and averaging measurements over several sites in each carotid artery.

Measurement best practiceImage the far wall of each common carotid artery for more accurate and reproducible CIMT measurements; two echogenic lines (lumen–intima and media–adventitia) define the measurement.

Guideline contextDescribed in the American Society of Echocardiography Carotid Intima‑Media Thickness Task Force consensus statement and referenced in guideline literature evaluating cardiovascular risk assessment using carotid ultrasound.

Clinical implicationAlthough investigated for risk stratification and monitoring, evidence is considered insufficient to demonstrate improved health outcomes for screening, diagnosis, or management in this policy context.

OpenPayer

Ultrasonographic Measurement of Carotid Intima-Medial Thickness (CIMT) as an Assessment of Subclinical Atherosclerosis

Coverage Criteria

Coding

Provider Actions & Billing Guidance

Background

Definitions