CurrentCapital BluecrossPolicy MP 5.017

Thermography

This policy governs the medical coverage stance for all forms of thermography for Capital BlueCross products and programs to which it applies, affecting providers who order, perform, or bill for thermographic procedures.

Policy Summary

PayerCapital Bluecross

PolicyThermography

Policy CodePolicy MP 5.017

Change TypeNo material change

Effective DateJan 1, 2026

Next Review DateSep 18, 2025

Key ActionDo not authorize thermography — all forms are investigational and may be denied.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

InvestigationalCoverage stance

2 listedProcedure codes

MultipleFDA-cleared devices

ReviewedBreast evidence

No statement changesPolicy history

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Not covered — investigational

Covered when ALL of the following are met:

Investigational coverage determination: The use of all forms of thermography is considered investigational due to insufficient evidence to support a general conclusion concerning health outcomes or benefits.

Applies across indications reviewed in the policy (breast cancer screening/diagnosis, musculoskeletal injuries, TMJ disorder, and miscellaneous conditions).

This policy applies to Capital BlueCross products and programs to which it is made applicable and is subject to product- and program-specific benefit variations. For members covered under the Federal Employee Program (FEP) refer to the FEP Medical Policy Manual (see FEP site). Payment and coverage for thermography services are ultimately determined by the member's benefit plan, eligibility on the date of service, and applicable contract terms, limitations, and exclusions.

The Centers for Medicare & Medicaid Services National Coverage Determination for thermography (NCD 220.11) is cited in the policy references and may be relevant to coverage determinations where federal NCDs apply. Providers should be aware that applicable NCD/LCD provisions could affect coverage for thermography services.

Rationale: Across clinical indications (breast cancer screening/diagnosis, musculoskeletal injuries, TMJ disorder, and miscellaneous conditions), the evidence base is dominated by diagnostic accuracy studies and systematic reviews that report wide and inconsistent ranges of sensitivity and specificity and, in many cases, lack a consistent reference standard. There are no studies demonstrating that thermography improves patient management or health outcomes compared with established diagnostic approaches. Consequently, the evidence is insufficient to determine improvement in net health outcomes, and the technology is considered investigational.

Recent policy reviews and consensus reviews documented in the policy history consistently note "No change to policy statement" across several review dates, with periodic updates to references and coding. These entries indicate that the investigational coverage stance has been reaffirmed by subsequent literature and administrative review, and that references and coding were reviewed without changing the coverage determination.

Evaluated Clinical Indications (literature review findings)

Breast cancer screening or diagnosis

Covered when ALL of the following are met:

Breast cancer screening/diagnosis: Systematic reviews and diagnostic accuracy studies report wide ranges of sensitivity and specificity; thermography has not been shown to be sufficiently accurate to replace or supplement mammography, and there are no studies demonstrating impact on patient management or health outcomes.

Musculoskeletal injuries

Covered when ALL of the following are met:

Musculoskeletal injuries: Evidence (diagnostic accuracy studies, a prospective study, and a systematic review) shows moderate and inconsistent accuracy with a lack of a consistent reference standard; there is no evidence that thermography improves patient management or health outcomes compared with standard testing.

Temporomandibular joint disorder

Covered when ALL of the following are met:

Temporomandibular joint disorder: A systematic review found wide variation in diagnostic accuracy and no consistent reference standard; no studies demonstrate impact on management or outcomes.

Miscellaneous conditions

Covered when ALL of the following are met:

Miscellaneous conditions (e.g., herpes zoster, pressure ulcers, diabetic foot, burns): Evidence is primarily diagnostic accuracy studies with small numbers per indication; clinical utility has been investigated in limited contexts (for example, a single study for diabetic foot ulcers); overall evidence is insufficient to determine that thermography improves net health outcomes.

Examples of miscellaneous indications are listed in the literature citations.

List of clinical indications evaluated in the literature cited

The literature cited in this policy includes studies evaluating thermography for multiple clinical indications:

Evidence topics cited: Studies and reviews evaluate thermography for temporomandibular disorders; prediction of postherpetic neuralgia in herpes zoster; pressure ulcer prediction and healing; burn depth assessment and healing potential; reconstructive flap monitoring and perforator detection; peripheral vascular and diabetic foot assessment; differentiation of melanocytic nevi vs melanoma; contact dermatitis; appendicitis; rheumatoid/inflammatory joint disease; and related applications.

See cited references for specific studies per indication.

Provider Actions, Billing & Documentation

Denial Risk

Investigational — Denial Risk

The use of all forms of thermography is considered investigational and is not covered. Claims for thermography may be denied as investigational; providers should obtain member benefit and eligibility information for the date of service to confirm any product-specific variations before billing.

Investigational — not covered; denial risk
Verify member benefit/eligibility on date of service
Final coverage determined by member's benefit contract; investigational services may be denied

Note

Product/Benefit Variations — Check Member Plan

This policy applies to specific Capital BlueCross products and programs and may be subject to benefit variations. Providers must follow product-specific benefit rules (for example, FEP PPO follows the FEP Medical Policy Manual). Review the member’s plan and any product-specific guidelines prior to providing or billing for thermography.

Check product-specific benefit variations before billing
FEP PPO: refer to FEP Medical Policy Manual (https://www.fepblue.org/benefit-plans/medical-policies-and-utilization-managementguidelines/medical-policies)

Documentation Required

Documentation & Coding Review

Ensure documentation supports the medical indication if thermography is billed despite the investigational stance; documentation will be reviewed and may not override investigational determination. Coding presence in this policy does not imply coverage.

Maintain thorough clinical documentation supporting the indication and medical necessity
Coding listed in the policy is not a guarantee of coverage

Prior Authorization

Prior Authorization — Verify Product Rules

No explicit prior authorization requirements are stated in this policy. However, because thermography is investigational and not covered, prior authorization will not make the service covered; verify if any specific product requires prior authorization for related services.

No prior authorization specified in this policy text
Confirm any product-specific prior authorization requirements with the member's plan

Definitions

Thermogram / Thermography — definition for thermogram

DefinitionThermogram — the visual display of temperature distribution measured by infrared radiation from skin or tissue using an infrared scanning device or heat-sensitive liquid crystal system.

Measurement basisDisplays temperature variations from skin or organ tissue as colored patterns via infrared radiation detection.

Device typesIncludes telethermographic infrared detector imaging and cholesteric liquid crystal (heat‑sensitive) systems.

Clinical role describedProposed as a diagnostic tool for treatment planning and evaluation of treatment effects across a variety of conditions.

Noninvasive natureA noninvasive imaging technique that measures temperature distribution in organs and tissues to produce the thermogram.

Thermography (infrared thermal imaging) — definition and scope as noninvasive imaging modality

Modality definitionThermography (infrared thermal imaging) — a noninvasive imaging modality that measures skin surface or tissue temperature patterns to assist assessment of inflammation, perfusion, wound healing potential, and other physiological processes.

How it is performedUses infrared scanning devices (including telethermographic detectors and infrared thermal cameras, including low‑cost smartphone‑based cameras in cited studies) to capture temperature distributions.

Clinical applications evaluatedHas been investigated for breast cancer screening/diagnosis, musculoskeletal and TMJ disorders, burn depth and healing, pressure‑ulcer prediction, diabetic foot assessment, reconstructive flap monitoring, lymph node metastasis detection, and other indications cited in the literature.

Limitations noted in policyAlthough multiple device types exist and studies are cited, evidence is insufficient to establish improved net health outcomes or to replace standard diagnostic tests; policy considers all forms investigational.

InterpretationColor/temperature patterns are interpreted to suggest areas of altered perfusion or inflammation and may assist in diagnosis or treatment planning in research and clinical reports.

Background

Background: Thermography is a noninvasive imaging technique that measures temperature distribution in tissues and produces a visual display (thermogram) using infrared scanning devices or heat-sensitive systems. It has been proposed for a range of diagnostic uses (for example, breast cancer screening/diagnosis, assessment of musculoskeletal injuries, temporomandibular joint disorders, diabetic foot and pressure ulcer assessment, burn depth evaluation, and reconstructive flap monitoring), but current evidence does not demonstrate reliable clinical utility or outcome benefit.

Policy Revision History

2025-09-18Consensus reviewLatest

Consensus review with updated background, rationale, and references; coding reviewed with no changes.

2024-11-07Consensus review

Consensus review with updated references and coding review (no changes).

2023-10-06Consensus review

Consensus review with updated references; no change to policy stance.

2022-11-23Consensus review

Consensus review with updated references; no change to policy stance.

2021-09-17Consensus review

Consensus review with updated references; no change to policy statement.

2020-08-11Consensus review

Consensus review with updated references, coding reviewed, and updated FDA table; no change to policy statements.

OpenPayer

Thermography

Coverage Criteria & Policy Stance

Not Covered / Investigational

Evaluated Clinical Indications (literature review findings)

Coding and Procedure Status

Provider Actions, Billing & Documentation

Definitions

Background

Policy Revision History

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