CurrentBlue Cross Blue Shield - Rhode IslandPolicy N/A

Transient elastography (FibroScan) for chronic liver disease — Evaluation and monitoring

This policy covers the use of transient elastography (FibroScan) as a noninvasive technique to evaluate (diagnose/stage) chronic liver disease and its stance on using the test for monitoring. It applies to Blue Cross Blue Shield - Rhode Island members (BlueCHiP for Medicare and Commercial products).

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

PolicyTransient elastography (FibroScan) for chronic liver disease — Evaluation and monitoring

Policy CodePolicy N/A

Change TypeNo material change

Effective DateJan 1, 2019

Next Review DateN/A

Key ActionVerify member benefits and eligibility with the provider call center prior to delivering services.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

CoveredCoverage for evaluation

Not coveredCoverage for monitoring

76981 / 91200Procedure codes

K70-K77Diagnosis codes

Systematic reviews

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.

Coverage Criteria for Transient Elastography (FibroScan)

inv-01: Evaluation (Initial Assessment)

Covered when ALL of the following are met

Evaluation coverage: Transient elastography (FibroScan) is covered/medically necessary for the evaluation (diagnosis/staging) of patients with chronic liver disease

Supported for detecting significant fibrosis and cirrhosis in viral hepatitis; evidence includes systematic reviews and observational studies across viral hepatitis, NAFLD, and ALD

inv-02: Monitoring (Follow-up)

Not covered when ANY of the following are present

Monitoring not covered: Transient elastography (FibroScan) is not covered / not medically necessary for monitoring of patients with chronic liver disease

Evidence is insufficient to determine the effects of the technology on health outcomes for monitoring

Transient elastography (FibroScan) has documented limitations that can affect test accuracy and may lead to failed examinations. The procedure performs less well or may fail in patients with ascites, higher body mass index (high BMI), or narrow intercostal margins, and it is not accurate during acute hepatitis or hepatitis exacerbations. In addition, FibroScan does not assess necroinflammatory activity or steatosis, and probe failures are reported more frequently in higher-BMI populations (newer probes may reduce but do not eliminate this limitation).

This policy covers the use of transient elastography (FibroScan) as a noninvasive diagnostic and staging tool for patients with chronic liver disease when used for initial evaluation. However, the policy explicitly does not cover the use of FibroScan for serial monitoring of patients with chronic liver disease; monitoring use is considered not medically necessary / not covered because current evidence is insufficient to demonstrate an effect on health outcomes.

Use of transient elastography (FibroScan) for routine follow-up or serial monitoring of patients with chronic liver disease is considered not medically necessary / not covered. The evidence has been judged insufficient to support monitoring to improve health outcomes.

If a service is determined to be not medically necessary under this policy, or when a medically necessary service is classified as a non-covered benefit under a member’s benefit documents, claims for that service may be denied. Providers should verify member benefits and eligibility prior to providing services, and may not bill or collect payment from the member for noncovered services unless there is a documented, written agreement with the member in advance.

Coding and Diagnosis Guidance

Covered CPT CodesCPTCovered

76981

Ultrasound, Elastography; Parenchyma (eg, Organ) (New code effective 1/1/2019) Liver elastography, mechanically induced shear wave (eg, vibration), without imaging

Covered CPT Codes (carrier-specific)CPTCovered

91200

with interpretation and report

Applicable Diagnosis CodesICD-10

K70.0-K77

Diagnosis codes for liver disease

Provider Actions, Documentation, and Billing

Prior Authorization

Prior authorization: Not applicable. This service does not require prior authorization under this policy.

Note

Benefit verification required

Verify member benefits and eligibility before performing services. Benefits may vary by contract; refer to the member's Benefit Booklet, Evidence of Coverage, or Subscriber Agreement. For member-specific benefit or eligibility questions, contact the provider call center.

Benefits and eligibility determined by subscriber/member certificate or employer agreement.
Contact provider call center for member-specific information.

Note

Benefit Verification

Verify benefits in the member's contract for coverage details; benefits and coverage limitations (including not medically necessary or not covered determinations) are determined by the subscriber agreement and may supersede this policy.

Background and Clinical Context

Liver biopsy remains the traditional reference standard for staging inflammation and fibrosis in chronic liver diseases (including HCV, HBV, NAFLD, and alcoholic liver disease). Biopsy provides histologic assessment used for Metavir-type staging of inflammatory activity and fibrosis, but it is invasive and subject to sampling error. Noninvasive tests such as transient elastography measure liver stiffness as a surrogate for fibrosis and have been validated for detection of significant fibrosis and cirrhosis, particularly in viral hepatitis populations, although they do not provide information on necroinflammatory activity or steatosis.

Definitions and Scoring Systems

Transient elastography (FibroScan) — method and units

MethodUltrasound-based transient elastography using a mechanical vibrator to induce shear waves that propagate through the liver

MeasurementLiver stiffness is measured as shear-wave speed and reported in kilopascals (kPa)

Probe/frequencyMechanical vibrator produces low-frequency (~50 Hz) waves tracked by ultrasound

Clinical useUsed to detect and stage liver fibrosis and cirrhosis as a noninvasive alternative to biopsy

Metavir scoring — histologic activity and fibrosis grades

Scoring domainsGrades inflammatory activity (A0–A3) and fibrosis (F0–F4)

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

PolicyTransient elastography (FibroScan) for chronic liver disease — Evaluation and monitoring

Policy CodePolicy N/A

Change TypeNo material change

Effective DateJan 1, 2019

Next Review DateN/A

Key ActionVerify member benefits and eligibility with the provider call center prior to delivering services.

SourceLink

On This Page

Benefits may vary by group/contract.
Subscriber/employer agreement controls coverage.

Denial Risk

Monitoring Not Covered

Transient elastography (FibroScan) is not covered for monitoring of chronic liver disease. Coverage may be denied when FibroScan is used solely for monitoring, as evidence is insufficient to support improved health outcomes for monitoring.

Not covered / not medically necessary for monitoring of chronic liver disease.
Covered/medically necessary only for evaluation of chronic liver disease as specified elsewhere in the policy.

Documentation Required

Coding and Diagnosis Documentation

Coding and documentation: Report procedure codes with interpretation and an accompanying report and include appropriate diagnosis codes. Covered procedure codes and required diagnoses include: CPT 76981 (Ultrasound Elastography; parenchyma) and CPT 91200 (with interpretation and report). Applicable diagnosis codes include K70.0 through K77.

Report interpretation and report when billing 91200.
Include an appropriate diagnosis from K70.0–K77 on the claim.

Denial Risk

Denial risk for non-covered or not medically necessary services

Services determined to be not medically necessary or non-covered under the member's benefit plan may be denied and the provider may not bill the member except as allowed by the member agreement and participation contract. Confirm coverage before providing services.

Verify member-specific coverage to avoid denial risk.
If services are non-covered or not medically necessary, providers generally may not bill the member unless prior written agreement exists.

Fibrosis scale meaningF0 = no fibrosis; F4 = cirrhosis

Activity scale meaningA0 = no or minimal activity; A3 = severe activity

Common useWidely used histologic scoring system for hepatitis C and other chronic liver diseases to stage fibrosis and necroinflammatory activity