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Thermography is a non-invasive imaging technique that is intended to measure temperature distribution of various organs and tissues. Thermography involves use of an infrared scanning device. The infrared radiation from the tissues reveals temperature variations by producing brightly colored patterns on a liquid crystal display. Interpretation of the color patterns is thought to assist in the diagnosis of many disorders such as breast cancer, Raynaud’s phenomenon, digital artery vasospasm in hand-arm vibration syndrome, impaired spermatogenesis in infertile men, degree of burns, deep vein thrombosis, gastric cancer, tear-film layer stability in dry-eye syndrome, Frey’s syndrome, headaches, low-back pain, reflex sympathetic dystrophy, and vertebral subluxation. Thermography is also thought to assist in treatment planning and procedure guidance such as identifying restricted areas of perfusion in coronary artery bypass grafting, assessing response to methylprednisone in rheumatoid arthritis, and locating high undescended testicles. The American Chiropractic Association suggests that high-resolution infrared imaging is of value in the diagnostic evaluation of patients when the clinical history suggests the presence of one of the following situations:

• To obtain early diagnosis and monitoring of reflex sympathetic dystrophy syndromes.
• To evaluate spinal nerve root fiber irritation and distal peripheral nerve fiber pathology for detection of sensory/autonomic dysfunction.
• To evaluate and monitor soft tissue injuries, including segmental dysfunction/subluxation, sprain and myofascial conditions (strains and myofascial pain syndromes) not responding to clinical treatment.
• To evaluate for the physiological significance of equivocal or minor anatomical findings seen on myelogram, computed tomography (CT) and/or magnetic resonance imaging (MRI).
• To evaluate for feigned disorders.

Thermography can include various types of telethermographic infrared detector images and heat-sensitive cholesteric liquid crystal systems.

In 2002, the Dorex Spectrum 9000 MD Thermography System (DOREX, Inc.; Orange, CA) was cleared for marketing by the U. S. Food and Drug Administration (FDA) through the 510(k) process. The FDA determined that this device was substantially equivalent to existing devices for use in quantifying and visualizing skin temperature changes. Its indicated use is as an aid in diagnosis and follow-up therapy in areas such as orthopedics, pain management, neurology and diabetic foot care. This type of device is also known as a telethermographic system.

In 2003, several teletheromographic cameras (Series A, E, P and S) by Flir Systems (McCordsville, IN) was cleared for marketing by the FDA through the 510(k) process. Their intended use is as an adjunct to other clinical diagnostic procedures when there is a need for quantifying differences in skin surface

Between 2006 and 2009, three new thermography devices received 510(k) marketing clearance from the FDA based on demonstrating substantial equivalence to existing products. 

The use of all forms of thermography is considered investigational.

Investigative service is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized by certifying boards and/or approving or licensing agencies or published peer review criteria as standard, effective medical practice for the treatment of the condition being treated and as such therefore is not considered medically necessary.

The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language.

2/14/2002: Investigational definition added

5/8/2002: Type of Service and Place of Service deleted

5/14/2002: Code Reference section completed

6/23/2004: Policy reviewed, Description section aligned with BCBSA policy # 6.01.12, Sources updated

8/25/2005: Code Reference section reviewed, no changes

3/5/2008: Policy reviewed, no changes

12/31/2008: Code Reference section updated per 2009 CPT/HCPCS revisions

3/30/2009: Policy reviewed, no changes

07/30/2010: Policy description updated regarding FDA status of devices. FEP verbiage added to the Policy Exceptions section. Removed deleted codes 93760 and 93762 from the coding section as they were deleted on 12/31/2008, and added 93799.

07/29/2011: Policy reviewed; no changes.

07/13/2012: Policy reviewed; no changes.

All codes billed for this procedure are considered investigational and not eligible for coverage. 

Non-Covered Codes

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