CurrentBlue Cross Blue Shield - Rhode IslandPolicy N/A

Bioimpedance devices for detection and lymphedema

Policy governs coverage determination for bioelectrical impedance spectroscopy (bioimpedance/BIS) devices used to diagnose, surveil, or treat lymphedema (including subclinical secondary lymphedema) for BlueCHiP for Medicare and Commercial products.

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

PolicyBioimpedance devices for detection and lymphedema

Policy CodePolicy N/A

Change TypeClarified / Informational update

Effective DateFeb 6, 2020

Next Review Date

Key ActionUse of CPT code 93702 is not medically necessary for BlueCHiP for Medicare and Commercial Products and will be denied/not covered.

SourceLink

POLICY UPDATE CHANGES

Policy last updated 02/06/2020 restates that bioimpedance devices are not covered due to insufficient evidence.

1Not Covered CPT codes listed

Insufficient evidenceCoverage rationale

Coverage Summary

Scope: This policy governs coverage determination for bioelectrical impedance spectroscopy (bioimpedance/BIS) devices used to diagnose, surveil, or treat lymphedema (including subclinical secondary lymphedema) for BlueCHiP for Medicare and Commercial products.

Overview: Bioimpedance spectroscopy is not covered for diagnosis, surveillance, or treatment of lymphedema; policy last updated 02/06/2020 and is informational reiterating the noncoverage stance.

Medical Necessity / Not Medically Necessary Criteria

Not Medically Necessary

Devices using bioimpedance (bioelectrical impedance spectroscopy) are considered not medically necessary when used for:

Not Medically Necessary Uses

Diagnosis of lymphedema (including secondary lymphedema)
Surveillance for lymphedema (including subclinical/ stage 0 lymphedema)
Treatment of patients with lymphedema

Commercial Products Statement

For Commercial Products the following applies:

Commercial Products Statement: Bioimpedance (bioelectrical impedance spectroscopy) is considered not medically necessary for diagnosis, surveillance, or treatment of lymphedema, including subclinical secondary lymphedema, due to insufficient evidence of effects on health outcomes.

Applies to Commercial Products as stated in policy.

Rationale and Evidence Summary

Bioimpedance spectroscopy measures tissue impedance as a surrogate for interstitial fluid volume and has been studied for detection of lymphedema and subclinical (stage 0) lymphedema, particularly after breast cancer surgery. Studies evaluate the technique by comparing impedance (which decreases with increased interstitial fluid) to limb-volume or circumference measurements.

Available evidence includes diagnostic accuracy studies that have shown poor correlation with reference standards and limited observational data; there are no randomized controlled trials demonstrating clinical utility, so the evidence is insufficient to determine effects on health outcomes.

Unsupported block type: evidence_summary

Unsupported block type: definitions

Provider Actions

Denial Risk

Claims for BIS (93702) will be denied

Use of CPT code 93702 is not medically necessary for BlueCHiP for Medicare and Commercial Products and will be denied/not covered.

93702

Documentation Required

Benefit verification required

Benefits may vary by contract; providers should refer to the member's Benefit Booklet, Evidence of Coverage, or Subscriber Agreement for specific coverage determinations.

Background

Bioimpedance spectroscopy (BIS) uses resistance to electrical current to compare fluid compartment composition and estimate extracellular fluid; in lymphedema, accumulation of interstitial fluid leads to decreased tissue impedance. Secondary upper-extremity lymphedema is a recognized complication after breast cancer surgery and can be chronic and disfiguring. Early detection (subclinical or stage 0 lymphedema) is of clinical interest because earlier intervention may improve outcomes, and BIS has been proposed as a surveillance tool to identify subtle changes before overt edema.

However, the clinical data are limited. Several prospective diagnostic studies report poor correlation between BIS and reference standards (volume displacement or circumferential measurement). Observational comparative studies have methodological limitations (retrospective design elements, lack of randomization or blinding, and inconsistent detection methods in control groups), and no randomized trials establish that BIS-based surveillance or management improves patient health outcomes.

Revision History

2020-02-06ClarifiedLatest

Policy last updated 02/06/2020 restates that bioimpedance devices are not covered due to insufficient evidence to determine effects on health outcomes; devices using bioimpedance (bioelectrical impedance spectroscopy) are not covered for diagnosis, surveillance, or treatment of lymphedema, including subclinical secondary lymphedema. CPT code 93702 is listed as not medically necessary.