Using low-dose x-rays of two different energy levels, whole body dual x-ray absorptiometry (DXA) measures lean tissue mass and total and regional body fat, as well as bone density. Measurements of body composition have been used to study how lean body mass and body fat change during health and disease. This has provided a research tool to study the metabolic effects of aging, obesity and various wasting conditions such as occurs with acquired immune deficiency syndrome (AIDS) or post-bariatric surgery.
Whole body dual x-ray absorptiometry (DXA) to determine body composition is considered investigational.
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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.
It is unclear how information regarding body composition could be used in the active medical management of an individual to improve health outcomes.
BlueCross BlueShield Association. Evidence Positioning System. (9:2018). Whole body dual x-ray absorptiometry to determine body composition (6.01.40). Retrieved October 30, 2018 from https://www.evidencepositioningsystem.com/ (12 articles and/or guidelines reviewed)
Imboden, M., Welch, W., Swartz, A., Montoye, A., Finch, H., Harber, M., et al. (2017). Reference standards for body fat measures using GE dual energy x-ray absorptiometry in caucasian adults. PLOS One, 12 (4), e0175110. (Level 4 evidence)
Rothney, M., Xia, Y., Wacker, W., Martin, F., Beaumont, M., Rezzi, S., et al. (2013). Precision of a new tool to measure visceral adipose tissue (VAT) using dual-energy x-ray absorptiometry (DXA). Obesity. 21, Vol. 21, No. 1; E124-E126. (Level 4 evidence)
Swainson, M., Batterham, A., Tsakirides, C., Rutherford, Z., and Hind, K.(2017). Prediction of whole-body fat percentage and visceral adipose tissue mass from five anthropometric variables. PLOS One, 12 (5), e0177175. (Level 3 evidence)
U. S. Food and Drug Administration. (2007, June). Center for Devices and Radiological Health. 510(k) Premarket Notification Database. K071570. Retrieved January 9, 2012 from http://www.accessdata.fda.gov.
ORIGINAL EFFECTIVE DATE: 8/14/2010
MOST RECENT REVIEW DATE: 12/13/2018
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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