BlueCross and BlueShield of Montana Medical Policy/Codes
Whole Body Computed Tomography (CT) Scan or Imaging as a Screening Test
Chapter: Radiology
Current Effective Date: September 24, 2013
Original Effective Date: September 05, 2012
Publish Date: September 24, 2013
Revised Dates: August 30, 2013
Description

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. CT scan is synonymous with computed axial tomography (CAT) scan.

Background

Whole body CT scans, encompassing the body from the neck to the pelvis, have been proposed as a general screening or scanning test for preventive, proactive or early detection methods or measures for healthy individuals who do not have any signs, symptoms or suspicion of disease, including but not limited to the following examples:

  • aneurysms, or
  • cysts in any location, or
  • emphysema, or
  • enlarged lymph nodes, or
  • gallstones, or
  • hiatal hernia, or
  • kidney stones, or
  • liver disease, or
  • osteoporosis, or
  • suspicious masses in other organs.

Often the CT screening test is marketed directly to the patient and is offered at a radiology center or through mobile CT scanners that travel from community to community. The whole body CT is performed without intravenous contrast and can be completed within ten minutes.

Types of CT systems that are promoted for screening may include, and are not limited to:

  • Full-body ultrafast (electron-beam) computed tomography (EBCT),Cine computed x-ray tomography, Dynamic contrast enhanced CT, Dynamic spatial reconstructor,       
  • Spiral CT,Helical CT, Multidetector row CT, or Multislice CT.

Frequently, the type of CT scanner used for whole body imaging is the EBCT, which utilizes advanced high-speed digital technology with rapid scan times to freeze moving structures (stop-action pictures) and to reduce or eliminate distortion and/or blurring usually created by motion. The scan needs only one-tenth of a second to make an x-ray image of the body area. This rapid scanning is made possible by an electron beam rather than the mechanical movement of an x-ray tube as required by conventional CT scanners. 

Helical or spiral CT uses different technology than EBCT. In recent years, helical CT has gained widespread clinical acceptance over older axial CT scanning technologies and EBCT. Helical CT may be performed on scanners with either single-detector or more advanced multi-detector CT or multi-slice CT imaging capabilities.

All of the technologies referred to above represent types of CT scans. Both EBCT and spiral or helical CT have demonstrated benefit over older generation scanners, due to their rapid acquisition times which reduce potential image degradation from motion (e.g., body movement as well as cardiac motion, respiration and bowel peristalsis, depending on the anatomic region under investigation).

The importance of CT is well established in numerous clinical scenarios, a few of which include diagnostic assessment for abnormal symptoms, physical exam and laboratory findings, trauma evaluation, and therapy planning. The intent of CT imaging under these circumstances is considered distinctly different from whole body CT as a screening test.

NOTE:  This policy addresses whole-body CT scan for screening. Different applications of rapid CT scanning as a screening or diagnostic test have been addressed in individual policies. Refer to the specific policies for those applications, e.g., cardiac or coronary artery, colonoscopy, lung, etc.

Policy

Each benefit plan, summary plan description or contract defines which services are covered, which services are excluded, and which services are subject to dollar caps or other limitations, conditions or exclusions.  Members and their providers have the responsibility for consulting the member's benefit plan, summary plan description or contract to determine if there are any exclusions or other benefit limitations applicable to this service or supply.  If there is a discrepancy between a Medical Policy and a member's benefit plan, summary plan description or contract, the benefit plan, summary plan description or contract will govern.

Coverage

Whole body computed tomography (CT) scans as a screening test are considered experimental, investigational and unproven.

Policy Guidelines

While there is no specific CPT code for whole body CT scanning, HCPCS issued S8092, which is specific for EBCT. A series of CPT codes that define CT scans for different aspects of the body may be reported.

Rationale

Literature searches using the MEDLINE database through March 2013 have identified a single controlled trial on whole-body computed tomography (CT) scans. In 2007, Obuchowski et al. reported a small (50 subjects) randomized trial of whole-body screening (vs. no screening for 3 years) to determine the feasibility of a larger scale study. (1) Ninety percent of the subjects were reported to be compliant with follow-up at 2 years. Images were interpreted independently by 6 radiologists from 2 institutions. Based on one interpretation, 16 (64%) subjects in the screening group had abnormal findings, but no cancers were detected. A second interpretation showed a similar rate of abnormal findings, although abnormalities were not in the exact same group of 16 subjects. On average, medical costs were twice as high for screened subjects. The authors concluded that a full-scale randomized controlled trial (RCT) of whole-body screening will need to account for the large variability in interpretation of the images, the high rate of incidental findings, and the low prevalence of cancers.

Also identified were 2 retrospective reviews of findings/recommendations from 982 and 1,192 whole-body CT screenings. (2, 3) Both studies observed a strong association between age of the patient and the number of findings and recommendations. Actionable findings ranged from 22.5% of subjects younger than 40 years of age to 80% of patients older than or equal to 80 years of age (2); follow-up imaging was the most common recommendation. (3)

Summary

Evidence has not changed substantially since a 2003 review that concluded “no published studies demonstrate that these procedures reduce morbidity or mortality when used to screen healthy, asymptomatic patients.” (4) Moreover, the radiation dose of the computed tomography (CT) scan itself could lead to an excess lifetime risk of fatal cancer and that radiation dose and associate risk should be included as fundamental parameters for investigating the outcomes of a CT-based screening program. (5) Evidence reviewed in a 2010 report from the Canadian Health Services Research Foundation indicates that whole-body CT screening uses 500 to 1,000 times the radiation levels of a routine chest x-ray, without any demonstrated positive effects on life expectancy. (6) The current literature does not support an improvement in health outcomes with whole-body CT screening.

Practice Guidelines and Position Statements

The American College of Radiology has posted the following statement regarding whole-body computed tomography (CT) scanning (7):

“The American College of Radiology (ACR) recognizes that an increasing number of computed tomography (CT) screening examinations are being performed in the United States. Much CT screening is targeted at specific diseases, such as lung scanning for cancer in current and former smokers, coronary artery calcium scoring as a predictor of cardiac events, and CT colonography (virtual colonoscopy) for colon cancer. Early data suggest that these targeted examinations may be clinically valid. Large, prospective, multicenter trials are currently under way or in the planning phase to evaluate whether these screening exams reduce the rate of mortality. The ACR, at this time, does not believe there is sufficient evidence to justify recommending total body CT screening for patients with no symptoms or a family history suggesting disease. To date, there is no evidence that total body CT screening is cost efficient or effective in prolonging life. In addition, the ACR is concerned that this procedure will lead to the discovery of numerous findings that will not ultimately affect patients' health but will result in unnecessary follow-up examinations and treatments and significant wasted expense. The ACR will continue to monitor scientific studies concerning these procedures.”

Information from the U.S. Food and Drug Administration (FDA) (8) indicates that recommendations from the U.S. Preventive Services Task Force and the American Medical Association have been added to those of the American College of Radiology, the American College of Cardiology/American Heart Association, the American Association of Physicists in Medicine, and the Health Physics Society, all of whom do not recommend CT screening. The FDA has published the following information on whole-body CT scanning:

“At this time the Food and Drug Administration (FDA) knows of no scientific evidence demonstrating that whole-body scanning of individuals without symptoms provides more benefit than harm to people being screened.”

  • “Whole-body CT screening has not been demonstrated to meet generally accepted criteria for an effective screening procedure.
  • Medical professional societies have not endorsed whole-body CT scanning for individuals without symptoms.
  • CT screening of high-risk individuals for specific diseases such as lung cancer or colon cancer is currently being studied.
  • The radiation from a CT scan may be associated with a very small increase in the possibility of developing cancer later in a person's life.”

Coding

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. 

ICD-9 Codes

87.41, 87.42, 87.71, 88.01, 88.02, 88.38, V76.0-V76.9, V81.0-V81.6

ICD-10 Codes

Z12.0-Z12.9, Z13.0-Z13.9, BW20ZZZ, BW21ZZZ, BW24ZZZ, BW25ZZZ, BW2GZZZ

Procedural Codes: 70490, 71250, 72125, 72128, 72131, 72192, 74150, 76120, 76125, 76499, S8092
References
  1. Obuchowski NA, Holden D, Modic MT et al. Total-body screening: preliminary results of a pilot randomized controlled trial. J Am Coll Radiol 2007; 4(9-Jan):604-11.
  2. Obuchowski N, Modic MT. Total body screening: predicting actionable findings. Acad Radio 2006; 13(4):480-5.
  3. Furtado CD, Aguirre DA, Sirlin CB et al. Whole-body CT screening: spectrum of findings and recommendations in 1192 patients. Radiology 2005; 237(2):385-94.
  4. Dixon GD. Computed tomography for screening purposes: a review of the literature--2003. Mo Med 2003; 100(2):140-4.
  5. Buls N, de Mey J, Covens P et al. Health screening with CT: prospective assessment of radiation dose and associated detriment. JBR-BTR 2005; 88(1):12-16.
  6. Canadian Health Services Research Foundation. Myth: whole-body screening is an effective way to detect hidden cancers. J Health Serv Res Policy 2010; 15(2-Jan):118-9.
  7. American College of Radiology. ACR Statement on Whole Body CT Screening. 2002. Available online at: http://www.acr.org . Last accessed March, 2013.
  8. U.S. Food and Drug Administration. Whole body scanning using computed tomography. Last update 04/06/2010. Available online at: http://www.fda.gov . Last accessed March, 2013.
  9. Whole Body Computed Tomography Scan as a Screening Test-Archived. Chicago, Illinois: Blue Cross Blue Shield Association Medical Policy Reference Manual (April 2013) Radiology 6.01.41.
History
September 2012 New policy considered Investigational
September 2013 Policy formatting and language revised.  Policy statement unchanged.  Title changed from "Whole-Body Computed Tomography Scan as a Screening Test" to "Whole Body Computed Tomography (CT) Scan or Imaging as a Screening Test".  Added codes 70490, 71250, 72125, 72128, 72131, 72192, 74150, 76120, 76125, 76499, S8092.
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Whole Body Computed Tomography (CT) Scan or Imaging as a Screening Test