Thermography is a non-invasive imaging technique which measures temperature distribution in organs and tissue (e.g., Dorex Spectrum 9000 MD Thermography System, Infrared Sciences Breastscan IR System, Notouch Breastscan, WoundVision Scout, FirstSense Breast Exam®). 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.
The use thermography for the evaluation and treatment of any condition is considered investigational.
Any specific products referenced in this policy are just examples and are intended for illustrative purposes only. It is not intended to be a recommendation of one product over another, and is not intended to represent a complete listing of all products available. These examples are contained in the parenthetical e.g. statement.
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.
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.
American College of Radiology (ACR). (2015) ACR Appropriateness Criteria® myelopathy. Retrieved May 16, 2018 from www.acr.org.
BlueCross BlueShield Association. Evidence Positioning System. (9:2018). Thermography. (6.01.12) Retrieved April 25, 2019 from https://www.evidencepositioningsystem.com/. (26 articles and/or guidelines reviewed)
Centers for Medicare & Medicaid Services. CMS.gov. NCD for thermography (220.11). Retrieved August 9, 2016 from http://www.cms.gov.
deMelo, DP., Bento, PM., Peixoto, LR., Martins, SKLD., & Martins, CC. (2019). Is infrared thermography effective in the diagnosis of temporomandibular disorders? A systematic review. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, 127 (2), 185-192. Abstract retrieved April 25, 2019 from PubMed database.
National Comprehensive Cancer Network. (2018, October). NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®). Breast cancer screening and diagnosis. Retrieved April 25, 2019 from the National Comprehensive Cancer Network.
Society of Breast Imaging. (2019). Breast thermography SBI position statement. Retrieved April 25, 2019 from https://www.sbi-online.org.
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: 7/1982
MOST RECENT REVIEW DATE: 5/9/2019
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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