Thermography
DESCRIPTION
Thermography is a non-invasive imaging technique that is intended to measure temperature distribution of various organs and tissues. The infrared radiation from the tissues reveals temperature variations by producing brightly colored patterns on a liquid crystal display. Interpretation of these color patterns, according to designated anatomic distribution, is thought to aid in diagnosing a vast array of diseases.
Thermography can include various types of telethermographic infrared detectors/imagers. Thermography can also include heat-sensitive cholesteric liquid crystal systems.
POLICY
The use of all forms of thermography for the treatment of any condition is considered investigational.
IMPORTANT REMINDER
We develop Medical Policies to provide guidance to Members and Providers. This Medical Policy relates only to the services or supplies described in it. The existence of a Medical Policy is not an authorization, certification, explanation of benefits or a contract for the service (or supply) that is referenced in the Medical Policy. For a determination of the benefits that a Member is entitled to receive under his or her health plan, the Member's health plan must be reviewed. If there is a conflict between the Medical Policy and a health plan, the express terms of the health plan will govern.
ADDITIONAL INFORMATION
The scientific literature is inadequate to validate the clinical role of thermography. No published studies were found that demonstrated how the results of thermography could be used to enhance an individual's management and improve health outcomes.
SOURCES
American College of Occupational and Environmental Medicine (ACOEM). (2007). Low back disorders. Occupational medicine practice guidelines: Evaluation and management of common health problems and functional recovery in workers. Retrieved November 16, 2011 from http://www.guideline.gov.
American College of Occupational and Environmental Medicine (ACOEM). (2008). Chronic pain. Retrieved November 16, 2011 from http://www.guideline.gov.
American College of Radiology (ACR). (2008). ACR appropriateness criteria® low back pain. Retrieved November 17, 2011 from http://www.guideline.gov.
American College of Radiology (ACR). (2008). ACR appropriateness criteria® myelopathy. Retrieved November 16, 2011 from http://www.guideline.gov.
American Society of Breast Surgeons. (2008). Effectiveness of a noninvasive digital infrared thermal imaging system in the detection of breast cancer. The American Journal of Surgery, 196, p. 523-526. (Level 3 Evidence - Industry sponsored)
BlueCross BlueShield Association. Medical Policy Reference Manual. (5:2011). Thermography (6.01.12). Retrieved November 16, 2011 from BlueWeb. (15 articles and/or guidelines reviewed)
Boyce, J. A., Assa’ad, A., Burks, A. W., Jones, S. M., Sampson, H. A., Wood, R. A., et al. (2010). Guidelines for the diagnosis and management of food allergy in the United States: report of the NIAID-sponsored expert panel. Retrieved November 16, 2011 from http://www.guideline.gov.
Browner, B. D., Jupiter, J. B., Levine, A. M., Trafton, P. G., & Krettek, C. (Eds.) (2008). Skeletal trauma (4th ed.). Retrieved November 17, 2011 from http://www.mdconsult.com/books/linkTo?type=bookPage&isbn=978-1-4160-2220-6&eid=4-u1.0-B978-1-4160-2220-6..10020-9--s0410.
Complete Guide to Medicare Coverage Issues [Computer software]. (2011, November). Thermography (NCD 220.11, p. 2-188). Ingenix.
Galvin, E. M., Niehof, S., Medina, H. J., Zijlstra, F. J., vanBommel, J., Klein, J., et al. (2006). Thermographic temperature measurement compared with pinprick and cold sensation in predicting the effectiveness of regional blocks. Anesthesia and Analgesia, 102 (2), 598-604. (Level 3 Evidence - Independent sponsored)
Katz, V. L., Lentz, G. M., Lobo, R. A., & Gershenson, D. M. (Eds.). (2007). Comprehensive gynecology (5th ed.). Retrieved November 17, 2011 from http://www.mdconsult.com/books/linkTo?type=bookPage&isbn=978-0-323-02951-3&eid=4-u1.0-B978-0-323-02951-3..50018-2--cesec9.
Larbig, M., Burtin, B., Martin, L., Stamm, H., Luettig, B., Hohlfeld, J. M., et al. (2006). Facial thermography is a sensitive tool to determine antihistaminic activity: Comparison of levocetirizine and fexofenadine. British Journal of Clinical Pharmacology, 62 (2), 158-164. (Level 2 Evidence - Industry sponsored)
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 November 17, 2011 from http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/ucm257259.htm.
Work Loss Data Institute. (2008). Low back - lumbar & thoracic (acute & chronic). Retrieved November 16, 2011 from http://www.guideline.gov.
Work Loss Data Institute. (2008). Pain (chronic). Retrieved November 16, 2011 from http://www.guideline.gov.
Work Loss Data Institute. (2011). Neck and upper back (acute & chronic). Retrieved November 16, 2011 from http://www.guideline.gov.
ORIGINAL EFFECTIVE DATE: 7/1982
MOST RECENT REVIEW DATE: 1/12/2012
ID_BA
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.
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