Coverage Policies

Important! Please note:

Current policies effective through April 30, 2024.

Take me to policies effective May 1, 2024.

Use the index below to search for coverage information on specific medical conditions.

High-Tech Imaging: High-Tech Imaging services are administered by Evolent. For coverage information and authorizations, click here.

Medical Providers: Payment for care or services is based on eligibility, medical necessity and available benefits at time of service and is subject to all contractual exclusions and limitations, including pre-existing conditions if applicable.

Future eligibility cannot be guaranteed and should be rechecked at time of service. Verify benefits by signing into My Account or calling Customer Service at 800.235.7111 or 501.228.7111.

QualChoice follows care guidelines published by MCG Health.

Clinical Practice Guidelines for Providers (PDF)

QualChoice reserves the right to alter, amend, change or supplement medical policies as needed. QualChoice reviews and authorizes services and substances. CPT and HCPCS codes are listed as a convenience and any absent, new or changed codes do not alter the intent of the policy.

INDEX:



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.