BlueCross BlueShield of Tennessee Medical Policy Manual

Thermography

DESCRIPTION

Thermography is a non-invasive imaging technique which measures temperature distribution in organs and tissue (e.g., Dorex Spectrum 9000 MD Thermography System).  Thermography involves the use of an infrared scanning device and can include various types of telethermographic infrared detector images and heat-sensitive cholesteric liquid crystal systems. Infrared radiation from the skin or organ tissue reveals temperature variations by producing brightly colored patterns on a liquid crystal display. Interpretation of the color patterns is thought to assist in the diagnosis and/or treatment of many disorders such as complex regional pain syndrome, breast cancer, Raynaud phenomenon, digital artery vasospasm in hand-arm vibration syndrome, peripheral nerve damage following trauma, deep vein thrombosis and low back pain.

POLICY

IMPORTANT REMINDERS

ADDITIONAL INFORMATION  

The scientific literature has not adequately evaluated the diagnostic accuracy or clinical utility of thermography. The evidence is insufficient to determine the effects of the technology on health outcomes.

SOURCES 

American College of Radiology (ACR). (2012) ACR Appropriateness Criteria® claudication – suspected vascular etiology. Retrieved April 16, 2014 from the National Guideline Clearinghouse (NGC:009248).

American College of Radiology (ACR). (2015) ACR Appropriateness Criteria® myelopathy. Retrieved August 9, 2016 from the National Guideline Clearinghouse (NGC:010841).

American College of Radiology (ACR). (2016) ACR Appropriateness Criteria® breast cancer screening. Retrieved May 26, 2017 from the National Guideline Clearinghouse (NGC:011028).

BlueCross BlueShield Association. Medical Policy Reference Manuel. (9:2016) Thermography. (6.01.12) Retrieved May 26, 2017 from BlueWeb. (19 articles and/or guidelines reviewed)

Centers for Medicare & Medicaid Services. CMS.gov. (1992, December) National Coverage Determination: (NCD) for thermography (220.11). Retrieved August 9, 2016 from: http://www.cms.gov.

U.S. Food and Drug Administration. (2002, November). Center for Devices and Radiological Health. Premarket notification database K023434. Retrieved August 9, 2016 from http://www.fda.gov.

U.S. Food and Drug Administration. (2011, June). Center for Devices and Radiological Health. FDA Safety Communication: Breast Cancer Screening - Thermography is Not an Alternative to Mammography. Retrieved April 16, 2014 from http://www.fda.gov.

ORIGINAL EFFECTIVE DATE:  6/1/2000

MOST RECENT REVIEW DATE:  7/13/2017

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Policies included in the Medical Policy Manual are not intended to certify coverage availability. They are medical determinations about a particular technology, service, drug, etc. While a policy or technology may be medically necessary, it could be excluded in a member's benefit plan. Please check with the appropriate claims department to determine if the service in question is a covered service under a particular benefit plan. Use of the Medical Policy Manual is not intended to replace independent medical judgment for treatment of individuals. The content on this Web site is not intended to be a substitute for professional medical advice in any way. Always seek the advice of your physician or other qualified health care provider if you have questions regarding a medical condition or treatment.

This document has been classified as public information.