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This policy addresses whole-body computed tomography (CT) scanning or whole-body CT screening as a potential preventive measure for individuals who have no signs or symptoms of disease.
Whole body CT scans, 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. Different aspects of whole body CT scanning as a screening test have been addressed in individual policies, i.e., spiral CT scanning as a screening test for lung cancer is addressed in the Helical Computed Tomography (Spiral CT) for Lung Cancer Screening policy; CT colonography as a screening test for colon cancer is addressed in the Colonscopy, Flexible Sigmoidoscopy, and CT Colonography policy; and CT scanning to detect coronary calcium is addressed in the Computed Tomography to Detect Coronary Artery Calcification policy.
POLICYWhole body computed tomography scans as a screening test are considered investigational.
POLICY EXCEPTIONSFederal Employee Program (FEP) may dictate that all FDA-approved devices, drugs or biologics may not be considered investigational and thus these devices may be assessed only on the basis of their medical necessity.
The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language.
Investigative is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized as a generally accepted standard of good medical practice for the treatment of the condition being treated and; therefore, is not considered medically necessary. For the definition of Investigative, “generally accepted standards of medical practice” means standards that are based on credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community, and physician specialty society recommendations, and the views of medical practitioners practicing in relevant clinical areas and any other relevant factors. In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting.
POLICY HISTORY7/2003: Approved by Medical Policy Advisory Committee (MPAC)
11/13/2006: Policy reviewed, no changes
3/29/2007: Policy reviewed, description updated, no changes to policy statement
6/3/2009: Policy reviewed, no changes
05/28/2010: Policy description updated. Policy statement unchanged. FEP verbiage added to the Policy Exceptions section. Deleted outdated references from the sources section.
07/29/2011: Policy reviewed; no changes.
05/09/2012: Policy reviewed; no changes.
07/23/2015: Code Reference section updated for ICD-10.
06/08/2016: Policy number L.6.01.417 added. Investigative definition updated in Policy Guidelines section.
SOURCE(S)Blue Cross Blue Shield Association policy #6.01.41
CODE REFERENCEThis may not be a comprehensive list of procedure codes applicable to this policy.
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