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Date Printed: June 26, 2017: 11:27 AM

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This medical policy (medical coverage guideline) is Copyright 2017, Blue Cross and Blue Shield of Florida (BCBSF). All Rights Reserved. You may not copy or use this document or disclose its contents without the express written permission of BCBSF. The medical codes referenced in this document may be proprietary and owned by others. BCBSF makes no claim of ownership of such codes. Our use of such codes in this document is for explanation and guidance and should not be construed as a license for their use by you. Before utilizing the codes, please be sure that to the extent required, you have secured any appropriate licenses for such use. Current Procedural Terminology (CPT) is copyright 2017 American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values, or related listings are included in CPT. The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS restrictions apply to government use. CPT® is a trademark of the American Medical Association. The use of specific product names is illustrative only. It is not intended to be a recommendation of one product over another, and is not intended to represent a complete listing of all products available.

04-70450-25

Original Effective Date: 09/15/09

Reviewed: 02/23/17

Revised: 03/15/17

Subject: Whole Body Computed Tomography (CT)

THIS MEDICAL COVERAGE GUIDELINE IS NOT AN AUTHORIZATION, CERTIFICATION, EXPLANATION OF BENEFITS, OR A GUARANTEE OF PAYMENT, NOR DOES IT SUBSTITUTE FOR OR CONSTITUTE MEDICAL ADVICE. ALL MEDICAL DECISIONS ARE SOLELY THE RESPONSIBILITY OF THE PATIENT AND PHYSICIAN. BENEFITS ARE DETERMINED BY THE GROUP CONTRACT, MEMBER BENEFIT BOOKLET, AND/OR INDIVIDUAL SUBSCRIBER CERTIFICATE IN EFFECT AT THE TIME SERVICES WERE RENDERED. THIS MEDICAL COVERAGE GUIDELINE APPLIES TO ALL LINES OF BUSINESS UNLESS OTHERWISE NOTED IN THE PROGRAM EXCEPTIONS SECTION.

           
Position Statement Billing/Coding Reimbursement Program Exceptions Definitions Related Guidelines
           
Other References Updates    
           

DESCRIPTION:

Whole body computed tomography (CT) scan, encompassing the body from the neck to the pelvis have been proposed as a general screening test for diseases of the thyroid (i.e., cancer), lungs (i.e., lung cancer), heart (i.e., cardiovascular disease), and abdominal and pelvic organs (cancer, cardiovascular disease). Often the test is marketed directly to the patient and is offered through mobile CT scanners that travel from community to community. According to the American College of Radiology and U.S. Food and Drug Administration, there is no evidence or data to support the use of whole body CT scanning for disease screening in asymptomatic individuals.

POSITION STATEMENT:

Whole body computed tomography scanning is considered investigational or experimental when used as a screening test (e.g., in patients without signs and symptoms of disease). Current literature does not support the use of whole body CT scanning for disease screening in asymptomatic individuals and improvement in health outcomes.

BILLING/CODING INFORMATION:

There is no specific CPT or HCPCS code to describe whole body CT scanning.

REIMBURSEMENT INFORMATION:

Refer to section entitled POSITION STATEMENT.

PROGRAM EXCEPTIONS:

Coverage for the radiology services referenced in this guideline performed and billed in an outpatient or office location will be handled through the BCBSF Radiology Management program for select products. The National Imaging Associates (NIA) will determine coverage for these services for select products. Refer to member's contract benefits.

Federal Employee Program (FEP): Follow FEP guidelines.

Medicare Advantage products:

No National Coverage Determination (NCD) and/or Local Coverage Determination (LCD) were found at the time of the last guideline reviewed date.

DEFINITIONS:

No guideline specific definitions apply.

RELATED GUIDELINES:

Computed Tomography to Detect Coronary Artery Calcification, 04-70450-02
Computed Tomographic Angiography (CTA) for Coronary Artery Evaluation, 04-70450-03

Computed Axial Tomography (CT), Head/Brain 04-70450-18

Computed Axial Tomography (CT), Temporal Bone/Mastoid & Maxillofacial 04-70450-19

Computed Axial Tomography (CT), of the Neck for Soft Tissue Evaluation 04-70450-20

Computed Axial Tomography (CT), Thorax 04-70450-21

Computerized Axial Tomography (CT) Abdomen and Pelvis 04-70450-22

Computed Axial Tomography (CT), Spine (Cervical, Thoracic, Lumbar) 04-70450-23

Computed Axial Tomography (CT), Extremity (Upper & Lower) 04-70450-24

OTHER:

Other names used to report whole body CT scanning:

Computerized Axial Tomography (CAT)
Computed Tomography, Whole Body
CT Scan, Whole Body
Full-Body CT Screening
Total Body CT
Total-Body Screening
Whole Body CT Scan
Whole-Body CT Screening
Whole-Body CT Screening Tool
X-ray Computed Tomography (CT)

REFERENCES:

  1. American Cancer Society: Computed Tomography (CT) Scans and Cancer, 2013.
  2. American College of Radiology (ACR) Statement on Whole Body CT Screening, 09/28/02.
  3. Beinfield MT, Wittenberg E, Gazelle GS. Cost-effectiveness of whole-body CT screening. Radiology 2005; 234: 415-422.
  4. Blue Cross Blue Shield Association Whole Body Computed Tomography Scan as a Screening Test Medical Policy 6.01.41, 2013.
  5. Brenner DJ, Elliston CD. Estimated radiation risks potentially associated with full-body CT screening. Radiology. 2004; 232:735-738.
  6. Furtado CD, Aguirre DA, Sirlin CB et al. Whole-body CT screening: spectrum of findings and recommendations in 1192 patients. Radiology. 2005; 237: 385-394.
  7. Illes J, Fan E, Koenig BA. Self-referred whole-body CT imaging: current implications for health care consumers. Radiology. 2003; 228: 346-351.
  8. Kolber CT, Zipp G, Glendinning D et al. Patient expectations of full-body CT screening. American Journal of Roentgenology. 2007; 188: W297-W304.
  9. National Cancer Institute-Radiation risks and pediatric computed tomography (CT): A guide for health care providers, 12/12/08.
  10. U.S. Food and Drug Administration-Full-Body CT Scans-What You Need to Know, 2015.
  11. U.S. Food and Drug Administration Center for Devices and Radiological Health-Whole Body Scanning Using Computed Tomography (CT), 03/03.

COMMITTEE APPROVAL:

This Medical Coverage Guideline (MCG) was approved by the BCBSF Medical Policy & Coverage Committee on 02/23/17.

GUIDELINE UPDATE INFORMATION:

09/15/09

New Medical Coverage Guideline.

01/01/10

Revised BCBSF Radiology Management program exception section.

09/15/11

Annual review; maintain experimental or investigational position statement. Updated references.

05/11/14

Revision: Program Exceptions section updated.

03/15/17

Revision; updated other section and references.

Date Printed: June 26, 2017: 11:27 AM