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L.2.02.412
Ultrasonographic measurement of carotid intima-media (or intimal-medial) thickness (CIMT) refers to the use of B-mode ultrasound to determine the thickness of the two innermost layers of the carotid artery wall, the intima and the media. Detection and monitoring of intima-media thickening, which is a surrogate marker for atherosclerosis, may provide an opportunity to intervene earlier in atherogenic disease and/or monitor disease progression.
Coronary Heart Disease
Heart disease is the leading cause of mortality in the United States, accounting for more than half of all deaths. Coronary heart disease (CHD), also known as coronary artery disease, is the most common cause of heart disease. In a 2024 update on heart disease and stroke statistics from the American Heart Association, it was estimated that 720,000 Americans have a new coronary attack (first hospitalized myocardial infarction or CHD death) and 335,000 have a recurrent attack annually. An estimated 20.5 million Americans ≥20 years of age have CHD. The prevalence of CHD was higher for males than females in all age groups. Total CHD prevalence is 7.1% in US adults ≥20 years of age; CHD prevalence is 8.7% for males and 5.8% for females. On the basis of data from the 2018 National Health Interview Survey, CHD prevalence estimates are 5.7% among White people, 5.4% among Black people, 8.6% among American Indian/Alaska Native people, and 4.4% among Asian people ≥18 years of age.
Established major risk factors for CHD have been identified by the National Cholesterol Education Program Expert Panel. These risk factors include elevated serum levels of low-density lipoprotein cholesterol and total cholesterol, and reduced levels of high-density lipoprotein cholesterol. Other risk factors include a history of cigarette smoking, hypertension, family history of premature CHD, and age.
Diagnosis
The third report of the National Cholesterol Education Program Adult Treatment Panel established various treatment strategies to modify the risk of CHD, with emphasis on target goals of low-density lipoprotein cholesterol. Pathology studies have demonstrated that levels of traditional risk factors are associated with the extent and severity of atherosclerosis. The third report of the National Cholesterol Education Program Adult Treatment Panel recommended use of the Framingham criteria to further stratify those patients with two or more risk factors for more intensive lipid management. 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. Thus, there has been an interest in identifying a technique that can improve the ability to diagnose those at risk of developing CHD, as well as to measure disease progression, particularly for those at intermediate risk.
The carotid arteries can be well-visualized by ultrasonography, and ultrasonographic measurement of the carotid intima-media thickness (CIMT) has been investigated as a technique to identify and monitor subclinical atherosclerosis. B-mode ultrasound is most commonly used to measure the carotid intima-media thickness. Carotid intima-media 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 carotid intima-media thickness measurements than imaging of the near wall. Two echogenic lines are produced, representing the lumen-intima interface and the media-adventitia interface. The distance between these two lines constitutes the carotid intima-media thickness.
In 2003, SonoCalc® (SonoSite) was cleared for marketing by the U.S. Food and Drug Administration (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 IMT of the carotid artery from images obtained from ultrasound systems. Subsequently, other devices have been cleared for marketing by the FDA through the 510(k) process. Product code: LLZ.
Ultrasonographic measurement of carotid intima-media thickness (CIMT) as a technique for identifying subclinical atherosclerosis is considered investigational for use in the screening, diagnosis, or management of atherosclerotic disease.
Federal 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.
12/14/2006: Policy added.
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.
10/16/2013: Policy reviewed; no changes.
08/18/2014: Policy reviewed; description updated. Policy statement revised to change "intimal-medial" to "intima-medial." Intent of policy statement unchanged.
12/31/2014: Added the following new 2015 CPT code to the Code Reference section: 93895.
07/23/2015: Code Reference section updated for ICD-10.
11/03/2015: Policy description updated. Policy statement unchanged. Investigative definition updated in policy guidelines section.
06/06/2016: Policy number A.2.02.16 added.
01/27/2017: Policy description updated. Policy statement unchanged.
06/01/2018: Policy description updated. Policy statement updated to change "carotid artery intima-medial thickness" to "carotid intima-media thickness."
06/04/2019: Policy reviewed; no changes.
06/12/2020: Policy reviewed; no changes.
12/22/2020: Code Reference section updated regarding deleted CPT code.
07/26/2021: Policy description updated regarding heart disease. Policy statement unchanged.
06/08/2022: Policy description updated regarding coronary heart disease. Policy statement unchanged. Code Reference section updated to remove deleted CPT code 0126T.
06/06/2023: Policy description updated regarding coronary heart disease. Policy statement unchanged.
06/14/2024: Policy description updated. Policy statement unchanged.
08/28/2024: Policy updated to change medical policy number from “A.2.02.16” to “L.2.02.412.”
Blue Cross Blue Shield Association Policy # 2.02.16
This may not be a comprehensive list of procedure codes applicable to your policy.
Code Number | Description |
CPT-4 | |
93895 | Quantitative carotid intima media thickness and carotid atheroma evaluation, bilateral |
HCPCS | |
ICD-10 Procedure | |
ICD-10 Diagnosis |
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