Blue Cross and Blue Shield of Montana (BCBSMT) considers the use of all forms of thermography experimental, investigational and unproven.
This policy was originally created in 1990 and was updated regularly with searches of the MEDLINE database. The most recent literature search was performed for the period March 2010 through March 2011. Following is a summary of the key literature to date:
No published studies have demonstrated how the results of thermography can be used to enhance patient management and/or improve patient health outcomes. The studies identified in literature searches tended to be small feasibility-type studies. Several studies included patients with complex regional pain syndrome (CRPS). For example, a study by Krumova et al. reported on skin temperature measurements in 22 patients with CRPS, 18 with non-CRPS pain, and 23 healthy controls. Using long-term thermography, there was asymmetry in limb temperature in the CRPS group and, to some extent, in non-CRPS pain patients that was not seen in healthy controls. However, the significance of these results is uncertain. Some of the differences could be due to effects of medication, e.g., antiseizure or antidepressant medications. In addition, the similarity of some findings between those with CRPS and non-CRPS pain limits applicability for use in diagnosis. A study, by Schurmann and colleagues, reported on imaging in 18 patients with CRPS type I (CRPS I) and 13 patients with an incomplete clinical picture. Based on the study, the authors concluded that imaging methods (e.g., 3-phase bone scan, MRI, thermography) are not able to reliably differentiate between normal post-traumatic changes and changes due to CRPS I and that clinical findings remain the gold standard for diagnosis.
A study from Sweden, published in 2009, addressed the use of thermography for diagnosing foot problems in 65 diabetic patients. They were examined with a liquid crystal thermography instrument, the SpectraSole (Linkoping, Sweden), immediately after a routine diabetic foot examination. No device with this name has been cleared by the FDA for use in the U.S. The 65 patients underwent a total of 69 SpectraSole examinations; the authors did not report why some patients had more than one examination. The SpectraSole identified temperature differences between the right and left foot in 31 of the 69 examinations (45%). Forty-two physical examinations classified patients as having no or only minor problems. Of these, 11 (26%) were found to have temperature differences on the SpectraSole examination. The remaining 27 examinations classified patients as having several and/or large problem areas. Twenty (74%) of these were found to have temperature differences. The study did not include a gold standard comparison, and the accuracy of the thermographic device was not evaluated.
Thermography has also been considered in the diagnosis of breast cancer. In 2008, Arora and colleagues reported on the use of thermography on 92 patients who presented for a breast biopsy. When used in a screening mode (any positive reading was considered abnormal) for breast cancer, the sensitivity of thermography was 97% and specificity was 12%; when evaluated in a clinical mode (the lesion in question was used to determine an abnormal score), sensitivity was 90% and specificity was 44%. These results must be viewed as preliminary. The American College of Obstetrics and Gynecology (ACOG) does not recommend thermography for breast cancer screening.
Examples of other studies on thermography include evaluating the association between thermographic findings and post-herpetic neuralgia in patients with herpes zoster, surgical site healing in patients who underwent knee replacements, ulcer healing in patients with pressure ulcers, and post-treatment pain in patients with coccygodynia. All of these studies were conducted outside of the United States, and none examined the impact of thermography on patient management decisions or health outcomes.
There is insufficient evidence to support the use of thermography for diagnosis. Studies are lacking that thermography can accurately diagnose any condition or improve the accuracy of another diagnostic tool. Moreover, there are no published studies evaluating whether use of thermography in patient management, such as to select a treatment or determine treatment effectiveness, improves health outcomes. Thus, thermography is considered investigational.
Disclaimer for coding information on Medical Policies
Procedure and diagnosis codes on Medical Policy documents are included only as a general reference tool for each policy. They may not be all-inclusive.
The presence or absence of procedure, service, supply, device or diagnosis codes in a Medical Policy document has no relevance for determination of benefit coverage for members or reimbursement for providers. Only the written coverage position in a medical policy should be used for such determinations.
Benefit coverage determinations based on written Medical Policy coverage positions must include review of the member’s benefit contract or Summary Plan Description (SPD) for defined coverage vs. non-coverage, benefit exclusions, and benefit limitations such as dollar or duration caps.
Investigational for all codes. 88.81-88.89
G56.40, G56.41,G56.42, G57.70, G57.71, G57.72, G89.0, G89.2, G89.3, G89.4, G90.50, G90.51, G90.511, G90.512, G90.513, G90.519, G90.52, G90.521, G90.522, G90.523, G50.529, G90.59, M25.50, M25.51, M25.512, M25.519, M25.52, M25.521, M25.522, M25.529, M25.53, M25.531, M25.532, M25.539, M25.551, M25.552, M25.559, M25.56, M25.561, M25.562, M25,569, M25.57, M25.571, M25.572, M25.579, M54.00, M54.01, M54.02, M54.03, M54.04, M54.05, M54.06, M54.07, M54.08, M54.09, M51.1, M54.10, M54.11, M54.12, M54.13, M54.14, M54.15, M54.16, M54.17, M54.18, M54.2, M54.3, M54.30, M54.31, M54.32, M54.4, M54.40, M54.41, M54.42, M54.5, M54.6, M54.8, M54.81, M54.89, M54.9, M79.60, M79.601, M79.601, M79.602, M79.603, M79.604, M79.605, M79.606, M79.609, M79.62, M79.621, M79.622, M79.629, M79.631, M79.632, M79.639, M79.64, M79.641, M79.642, 79.643, M79.644, M79.645, M79.646, M79.65, M79.651, M79.652, M79.659, M79.66, M79.661, M79.662, M79.669, M79.67, M79.671, M79.672, M79.673, M79.674, M79.675,M79.676, R52