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Established major risk factors for coronary heart disease (CHD) have been identified by the National Cholesterol Education Program (NCEP) Expert Panel. These risk factors include elevated serum levels of low-density lipoprotein (LDL) cholesterol, total cholesterol, and high-density lipoprotein (HDL) cholesterol. Other risk factors include a history of cigarette smoking, hypertension, family history of premature CHD, and age. The third report of the NCEP Adult Treatment Panel (ATP III) establishes various treatment strategies to modify the risk of CHD, based in part on target goals of LDL cholesterol. Pathology studies have demonstrated that levels of traditional risk factors are associated with the extent and severity of atherosclerosis. However, at every level of risk factor exposure, there is substantial variation in the amount of atherosclerosis, presumably related to genetic susceptibility and the influence of other risk factors. Therefore, there has been interest in identifying a technique that can measure and monitor atherosclerosis that reflects the pathogenic endpoint of CHD risk factors. The carotid arteries can be well visualized by ultrasonography, and ultrasonographic measurements of the thickness of the carotid intimal medial (IMT) have been investigated as a technique to identify and monitor subclinical atherosclerosis.

B-mode ultrasound is most commonly used to measure CIMT.  The intimal-medial thickness is measured and averaged over several sites in each carotid artery.  Imaging of the far wall of each common carotid artery yields more accurate and reproducible IMT measurements than imaging of the near wall.  Two echogenic lines are producted which represent the lumen-intima interface and the medica-adventitia interface.  The distance between these two lines constitutes the IMT. 

In February 2003, SonoCalc® (SonoMetric Health, LLC, Bountiful UT) was cleared for marketing by the FDA through the 510(k) process. The FDA determined that this software was substantially equivalent to existing image display products for use in the automatic measurement of the intima media thickness of the carotid artery from images obtained from ultrasound systems. Subsequently, several other devices have been approved through the 510(k) process.

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

3/22/2007: Reviewed and approved by the Medical Policy Advisory Committee (MPAC)

6/19/2009: Policy reviewed, policy statement re-written for clarity 

07/16/2010:  Policy description updated to add information about the FDA status of devices. Policy statement unchanged.  FEP verbiage added to the Policy Exceptions section.

08/03/2011: Policy reviewed; no changes.

09/25/2012: Policy reviewed; no changes.

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

Non-Covered Codes