Thermography
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This policy governs the use and coverage determination for all forms of thermography for Capital BlueCross products (with product variations) and applies to providers submitting claims for thermographic procedures.
No material clinical or coverage changes in this revision.
Coverage Determination
Not covered — investigational
Covered when ALL of the following are met:
Includes breast cancer screening/diagnosis, musculoskeletal injuries, TMJ disorder, and miscellaneous conditions as discussed in the rationale and summary of evidence.
This policy applies only to certain Capital BlueCross programs and products and is subject to benefit variations. FEP PPO members should refer to the FEP Medical Policy Manual for the applicable policy and prior authorization requirements; the manual is available at the FEP Blue website. Coverage determinations for thermography will be made in accordance with member benefit terms for the specific product under which the member is enrolled.
Professional society guidance on breast cancer screening and diagnosis was reviewed and is referenced in this policy. Position statements and guideline documents from organizations such as the European Society of Breast Imaging (EUSOBI), American College of Radiology (ACR), American College of Physicians (ACP), U.S. Preventive Services Task Force (USPSTF), and NCCN inform that currently recommended breast cancer screening modalities do not include thermography as a replacement for mammography or other standard screening tests. These guideline references were considered in the assessment of thermography for breast cancer screening and diagnosis.
The policy designates all forms of thermography as investigational because the body of evidence is insufficient to demonstrate consistent test accuracy or clinical utility. Diagnostic accuracy studies and systematic reviews report wide ranges of sensitivity and specificity across indications (including breast cancer screening/diagnosis, musculoskeletal injuries, TMJ disorder, and miscellaneous conditions), and there are no studies showing that thermography improves patient management or net health outcomes. Given these limitations, the evidence does not support a conclusion that thermography produces an improvement in health outcomes.
Breast cancer screening guidance from multiple professional organizations and the referenced CMS National Coverage Determination for Thermography (NCD 220.11) were considered in evaluating thermography’s role in screening. These sources indicate that thermography is not established as an alternative to standard breast cancer screening modalities and that CMS has longstanding limitations on coverage for thermography, which informed the policy’s investigational stance.
Reviewed Clinical Applications (Not Covered / Investigational)
Breast cancer screening or diagnosis
Covered when ALL of the following are met:
Systematic reviews and diagnostic accuracy studies cited; evidence insufficient to determine improvement in net health outcomes.
Musculoskeletal injuries
Covered when ALL of the following are met:
Insufficient evidence to support replacement or supplementation of standard testing.
Temporomandibular joint disorder
Covered when ALL of the following are met:
Evidence insufficient to determine improvement in net health outcomes.
Miscellaneous conditions (herpes zoster, pressure ulcers, diabetic foot, burns)
Covered when ALL of the following are met:
Diagnostic accuracy could not be adequately evaluated for most indications.
Literature-reported clinical applications
Covered when ANY of the following literature-reported applications are being considered (these are research or investigational uses):
These literature-reported applications are cited in the policy but remain investigational; evidence does not establish clinical utility or improved outcomes.
Procedure and Billing Codes
| 220.11 | CMS National Coverage Determination for Thermography (identifier referenced as NCD 220.11) |
Provider Impact and Billing Guidance
Product variations — coverage subject to member benefit
This policy is applicable only to certain Capital BlueCross programs and products and coverage is subject to benefit variations; FEP PPO members should refer to the FEP Medical Policy Manual for their benefit rules.
- Policy applicability varies by product and program administered by Capital BlueCross.
- FEP PPO members: refer to the FEP Medical Policy Manual (link provided in policy).
Prior authorization not specified in policy
The policy document does not specify any explicit prior authorization requirement within the policy text.
- No prior authorization process or authorization codes are stated in the policy sections provided.
No step therapy — investigational means not covered
No step therapy requirements are specified in the policy; because thermography is designated investigational, the policy treats the service as not covered rather than as subject to staged therapy.
- Investigational designation means the service is not covered rather than placed into a step-therapy sequence.
No step therapy protocols provided
The policy contains no step-therapy protocols or sequencing requirements for thermography.
- Documented literature citations and clinical indications do not establish any step-therapy pathway in the policy.
Claims and documentation — submit standard supporting documentation
Providers should submit supporting documentation with claims according to standard claim requirements; listing a code in the coding section does not denote coverage or guarantee payment, which is determined by member benefits.
- Identification of a code in the coding section is not a statement of coverage.
- Coverage and payment remain subject to the terms of the member’s benefit information.
Policy history — consensus and coding reviews
Policy history reflects multiple consensus reviews and coding reviews without changes to the policy statement; follow payer-specific documentation and coding guidance as updated in the policy.
- Policy history entries show repeated consensus reviews with no change to policy stance (dates and notes listed in policy history).
- Providers should follow Capital BlueCross documentation and coding guidance as updated.
Investigational designation may lead to denied claims
The use of all forms of thermography is considered investigational; services may be denied as investigational when submitted for coverage.
- Policy statement: “The use of all forms of thermography is considered investigational…”
- Claims for thermography are subject to denial on the basis of investigational status.
CMS NCD 220.11 referenced — may affect coverage decisions
The policy references the Centers for Medicare & Medicaid Services National Coverage Determination for Thermography (NCD 220.11), which may influence coverage determinations for some members.
- Referenced NCD: CMS National Coverage Determination for Thermography (220.11).
Prior Authorization Notes
Confirm product before ordering — some products follow different manuals (e.g., FEP PPO)
Thermography policy applicability varies by product; product‑specific prior authorization rules may apply (for example, FEP PPO members must follow the FEP Medical Policy Manual referenced in the policy).
- Confirm whether the member’s product is covered by this Capital BlueCross policy before ordering.
- If the member is FEP PPO, consult the FEP Medical Policy Manual linked in the policy for applicable rules.
Services Considered Not Covered
All forms of thermography are considered investigational and therefore not covered. Procedure codes specifically identified in the policy as investigational when used for thermography include 93740 and 93799. Providers should note that listing of a code does not itself guarantee coverage; reimbursement is subject to member benefits and standard claim documentation requirements.
The policy does not support the use of thermography as a substitute for standard breast cancer screening modalities. Guideline statements from professional societies and the referenced CMS NCD 220.11 indicate thermography should not replace mammography or other recommended screening methods for breast cancer; therefore thermography used in place of standard screening is not covered under the investigational policy stance.
Definitions and Device Codes
Background Information
Thermography (also termed infrared thermal imaging or thermogram) is a noninvasive imaging technique that measures and displays the distribution of skin surface temperature, producing a thermogram. It includes technologies such as telethermographic infrared detectors and heat-sensitive liquid crystal systems and has been applied in studies for a variety of clinical questions (for example, burn assessment, diabetic foot evaluation, and detection of inflammatory or vascular changes), although diagnostic performance and clinical utility vary by indication.
Policy History and Revisions
Consensus review with updates to background, rationale, and references; coding reviewed with no changes.
Consensus review with reference updates and coding review with no changes to the policy statement.
Consensus review with updates; no change to policy stance.
Consensus review; references updated and no change to policy stance.
Consensus review with references updated; no change to policy statement.
Consensus review; references updated, coding reviewed, and FDA table updated; no change to policy statements.
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