Coverage Policies

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INDEX:
A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

Effective Date: 09/01/2013 Title: Thermography & Temperature Gradient Studies
Revision Date: Document: BI413:00
CPT Code(s): 93740
Public Statement

Effective Date:

a)    This policy will apply to all services performed on or after the above revision date which will become the new effective date.

b)    For all services referred to in this policy that were performed before the revision date, contact customer service for the rules that would apply.

Thermography and temperature gradient studies have not been demonstrated to improve health care outcomes.  These studies are not covered.


Medical Statement

Thermography and temperature gradient studies are considered experimental / investigational for any use.


Background

1)    Skin surface thermography studies are non-invasive techniques that measure skin surface temperatures in an attempt to determine the status of underlying organs.  This technique has been thought by some to contribute to diagnosis of many disorders, including breast cancer, Raynaud’s phenomenon, deep vein thrombosis, reflex sympathetic dystrophy, headaches, and vertebral subluxation. 

2)    Temperature gradient studies using intravenous catheters have been used to directly measure temperature differences on the inner walls of coronary arteries, in an attempt to determine the presence of unstable coronary artery plaques.

3)    The American Medical Association, the American College of Radiology, the National Headache Foundation, and the American College of Neurology have issued policy statements that do not recommend thermography or temperature gradient studies as diagnostic techniques.  While the Council on Chiropractic Practice issued a statement in 1998 that thermography is an established method to detect subluxation, there were no controlled studies listed to support a finding that use of thermography improved patient outcomes.


Reference

Agency for Healthcare Research and Quality (AHRQ). Vulnerable Plaques: A Brief Review of the Concept and Proposed Approaches to Diagnosis and Treatment. Jan 22, 2004.Available at:http://archive.ahrq.gov/clinic/ta/placque/placque.pdf.

 

American Cancer Society (ACS). Mammograms and other breast imaging procedures. 2010. Available at: Click here

 

American College of Obstetricians and Gynecologists (ACOG). Breast cancer screening. Washington (DC): American College of Obstetricians and Gynecologists (ACOG); 2011 Aug. 11p. (ACOG practice bulletin; no. 122).

 

American College of Radiology (ACR). ACR appropriateness criteria. Breast Cancer Screening. 2012. Available at:

http://www.acr.org/~/media/ACR/Documents/AppCriteria/Diagnostic/BreastCancerScreening.pdf

 

American College of Radiology (ACRb). ACR appropriateness criteria. Myelopathy. 2011.Available at: http://www.acr.org/~/media/ACR/Documents/AppCriteria/Diagnostic/Myelopathy.pdf

 

ECRI Institute. Thermography for Detection of Breast Masses. May 2011.

 

Harper CM Jr, Low PA, Fealey RD, et al. Utility of thermography in the diagnosis of lumbosacral radiculopathy. Neurology. 1991; 41(7):1010-1014.


Application to Products
This policy applies to all health plans administered by QualChoice, both those insured by QualChoice and those that are self-funded by the sponsoring employer, unless there is indication in this policy otherwise or a stated exclusion in your medical plan booklet. Consult the individual plan sponsor Summary Plan Description (SPD) for self-insured plans or the specific Evidence of Coverage (EOC) for those plans insured by QualChoice. In the event of a discrepancy between this policy and a self-insured customer’s SPD or the specific QualChoice EOC, the SPD or EOC, as applicable, will prevail. State and federal mandates will be followed as they apply.
Changes: QualChoice reserves the right to alter, amend, change or supplement benefit interpretations as needed.
This policy has recently been updated. Please use the index above or enter policy title in search bar for the latest version.