Thermography (Infrared Surface Temperature Imaging)
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This policy defines Eocco's coverage stance on thermography (infrared surface temperature imaging) and the circumstances under which thermography is considered experimental/investigational and not covered by the plan. It is directed to providers submitting requests for thermography services and prior authorization reviewers.
No material clinical or coverage changes in this revision.
Coverage Criteria
Not Medically Necessary / Experimental
Not covered — experimental/investigational
This is a blanket noncoverage statement; see CMS NCD 220.11 referenced in Appendix 2.
The Centers for Medicare & Medicaid Services has issued a National Coverage Determination specifically addressing thermography (NCD 220.11). This NCD indicates that thermography is not covered for all indications, and related Medicare coverage guidance should be consulted where applicable.
Thermography is considered experimental and investigational for all indications. Available medical literature indicates thermography is an ineffective diagnostic technique with no proven medical value, and therefore it is not medically necessary.
All proposed indications
Proposed indications described in the policy (none are considered medically necessary).
Indication for thermography
Examples of proposed indications
- Breast cancer screening (thermography) as a proposed use.
- Digital artery vasospasm (e.g., suspected vasospastic disease).
- Deep vein thrombosis (proposed diagnostic use).
- Raynaud phenomenon (evaluation of vasospasm).
- Other proposed indications: Other proposed diagnostic indications described in the policy description.
Not Covered
Thermography, including CPT/HCPCS code 93740 (temperature gradient studies), is not covered for any indication.
Coding
| 93740 | Temperature gradient studies |
| C95.91 | Leukemia, unspecified, in remission |
| E10.51 | Type 1 diabetes mellitus with diabetic peripheral angiopathy without gangrene |
| E10.65 | Type 1 diabetes mellitus with hyperglycemia |
| E11.51 | Type 2 diabetes mellitus with diabetic peripheral angiopathy without gangrene |
| E11.65 | Type 2 diabetes mellitus with hyperglycemia |
| I25.10 | Atherosclerotic heart disease of native coronary artery without angina pectoris |
| I25.810 | Atherosclerosis of coronary artery bypass graft(s) without angina pectoris |
| I25.811 | Atherosclerosis of native coronary artery of transplanted heart without angina pectoris |
| I79.8 | Other disorders of arteries, arterioles and capillaries in diseases classified elsewhere |
| M79.609 | Pain in unspecified limb |
| NCD 220.11 | CMS National Coverage Determination for Thermography — noncovered for all indications (per CMS) |
Provider Actions & Billing Implications
Prior authorization not applicable — service not covered
Prior authorization is not applicable because thermography is considered experimental and investigational for all indications and is not covered by the plan.
- Thermography is considered experimental and investigational for all indications.
- CPT/HCPCS code 93740 (temperature gradient studies/thermography) is listed as not covered.
Do not request authorization for thermography
Thermography services are not covered under this policy; do not submit requests expecting authorization approval.
- Thermography is experimental/investigational for all indications.
- CPT/HCPCS code 93740 is explicitly listed as not covered.
Information to submit: Not applicable
Not applicable — no information is required to be submitted with a prior authorization request for thermography.
- Section III: Information Submitted with the Prior Authorization Request: “Not applicable.”
Denial risk — thermography (CPT/HCPCS 93740)
Requests for thermography are subject to denial because the service is considered experimental/investigational and CPT/HCPCS code 93740 is listed as not covered.
- Thermography is considered experimental and investigational for all indications.
- CPT/HCPCS code 93740 (temperature gradient studies) is listed as not covered.
Background
Thermography is a non-invasive infrared imaging technique that measures and maps surface temperature variations of the body using infrared radiation to visualize patterns (for example, as color-coded displays). It has been proposed for uses such as breast cancer screening and evaluation of vascular conditions, but the literature does not demonstrate proven diagnostic value.
Definitions
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