CurrentBlue Cross Blue Shield - Rhode IslandPolicy N/A

Thermography Policy

Policy defines coverage stance for thermography (digital infrared thermography and related techniques) for BlueCHiP for Medicare and Commercial products; states thermography is considered not medically necessary due to insufficient evidence and gives billing guidance to report with an unlisted cardiovascular code.

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

PolicyThermography Policy

Policy CodePolicy N/A

Change TypeClarified - not medically necessary

Effective Date

Next Review Date

Key ActionReport thermography services using CPT code 93799 (Unlisted cardiovascular service or procedure); these services are considered not medically necessary and subject to benefit limitations.

SourceLink

POLICY UPDATE CHANGES

States that all forms of thermography are considered not medically necessary due to insufficient evidence.

1Coverage stance (not medically necessary)

93799Unlisted CPT code cited

10+References cited

Coverage Summary

The policy applies to thermography (digital infrared thermography and related techniques) for BlueCHiP for Medicare and Commercial products. The use of all forms of thermography is considered not medically necessary because evidence is insufficient to determine effects on health outcomes. Evidence supporting this stance includes multiple references and reviews concluding insufficient clinical utility (see references).

Medical-Necessity Determination

Medical Necessity Determination

The use of all forms of thermography is considered not medically necessary when used for diagnosis or treatment planning because evidence is insufficient to determine effects on health outcomes.

ALL of the following

Scope of thermography modalities: Thermography (including digital infrared thermography, telethermographic infrared detector images, heat-sensitive cholesteric liquid crystal systems, and other infrared scanning devices) used to diagnose or evaluate treatment effects for any condition
Evidence statement: Evidence is insufficient to support that thermography can accurately diagnose any condition or improve the accuracy of another diagnostic tool
Coverage determination: Therefore thermography is considered not medically necessary

Not Covered / Experimental

Policy stance: The use of all forms of thermography — including digital infrared thermography, telethermographic infrared detector images, heat-sensitive cholesteric liquid crystal systems, and other infrared scanning devices — is considered not medically necessary for diagnosis or treatment planning because the evidence is insufficient to determine effects on health outcomes.

Background summary: Infrared-based methods reveal skin or tissue temperature variations and have been proposed for diagnosis and treatment planning across numerous conditions, but sufficient data are lacking that thermography can accurately diagnose any condition or improve the accuracy of another diagnostic tool.

Provider Actions & Billing Impact

Billing Rule

Reporting Thermography

Report thermography services using CPT code 93799 (Unlisted cardiovascular service or procedure); these services are considered not medically necessary and subject to benefit limitations.

93799

Documentation Required

Benefit Determination

Verify member-specific benefits and limitations in the appropriate Benefit Booklet, Evidence of Coverage, or Subscriber Agreement as benefits may vary between groups/contracts.

Denial Risk

Potential Member Liability

If services are determined not medically necessary and not covered benefits, do not charge the member unless the member was informed and agreed in writing in advance to pay at their own expense.

Background, Evidence & Definitions

Thermography involves the use of an infrared scanning device to produce a thermogram by mapping temperature variations of skin and tissues. It has been proposed for diagnosing and guiding treatment for many conditions (for example, breast cancer, complex regional pain syndrome, musculoskeletal injuries, and others).

The policy concludes there is insufficient evidence that thermography can accurately diagnose conditions or improve diagnostic accuracy; therefore thermography is considered not medically necessary.

Evidence summary: Systematic reviews and studies cited (multiple references such as Vreugdenburg 2013 and Fitzgerald 2012) conclude there is insufficient evidence for clinical utility.

Source	Summary
Systematic reviews and studies cited	Multiple systematic reviews and studies (e.g., Vreugdenburg 2013; Fitzgerald 2012; others) conclude there is insufficient evidence that thermography has clinical utility for diagnosis or screening
Background section of policy	Thermography is a noninvasive infrared technique proposed for many conditions, but sufficient data are lacking that it can accurately diagnose any condition or improve another diagnostic tool; therefore it is considered not medically necessary
Coverage statement (BlueCHiP for Medicare and Commercial)	The use of all forms of thermography is considered not medically necessary because evidence is insufficient to determine effects on health outcomes
Billing guidance	There is no specific code for thermography; report services with CPT code 93799 (Unlisted cardiovascular service or procedure) and these services are considered not medically necessary

Thermography: A noninvasive imaging technique intended to measure temperature distribution in organs and tissues and produce a thermogram (visual display of temperature).

Revision History

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