Medical Policy


Subject:  Whole Body Computed Tomography Scanning
Policy #:  RAD.00037Current Effective Date:  01/14/2014
Status:ReviewedLast Review Date:  11/14/2013

Description/Scope

Whole body computed tomography (CT) screening typically involves scanning the body from the head to below the hips with a form of x-ray imaging that produces cross-sectional images. Each image slice corresponds to a wafer-thin section which can be viewed to reveal body structures in great detail. Medical imaging facilities nationwide are promoting this procedure to healthy individuals who have no symptoms of disease as a screening tool to detect early warnings of cancer, cardiac disease, and other abnormalities. This document addresses the use of various CT scanning modalities when used to perform whole body scans for general screening.

Note: Please see the following related documents for additional information:

Position Statement

Investigational and Not Medically Necessary:

The use of CT scanning, including conventional CT scanning, helical CT scanning, electron-beam CT (EBCT) or multislice CT (MSCT) is considered investigational and not medically necessary when used for whole body imaging for general screening (i.e., in individuals without signs or symptoms of disease).

Rationale

Currently, there is no evidence or data demonstrating that whole body CT screening is effective in detecting any particular disease early enough to have an effect on the management, treatment, or clinical outcome of disease. The benefits and risks of this method of screening have not been assessed in adequate clinical trials. In addition, these screening tests may unnecessarily expose individuals to harmful levels of radiation. There is also an increased risk of false positive findings that would lead to unnecessary invasive and noninvasive testing, which themselves pose increased health risks.

The American College of Radiology's (ACR) statement (2002) on whole body CT screening states:

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.

Total body CT screening uses much higher doses of radiation than are normally experienced during standard CT or x-ray procedures. This increased radiation exposure may increase the risk of developing cancer at some later point in time. A study by Zondervan and colleagues (2011) reported on 25,104 young adults (age 18 to 35 years old) who received chest or abdominopelvic CT scans. Frequency of scanning was defined as rarely (less than 5 scans of a given body part), moderately (greater than 5 scans and less than 15 scans), or frequently (greater than 15 scans). Cumulative radiation exposure was calculated from typical effective doses and was used to estimate cancer risk. The incidence of cancer and mortality were estimated using the Biologics Effects of Ionizing Radiation method. The most common diagnoses for scanning were cancer, organ transplant, leukemia or lymphoma with bone marrow transplant, inflammatory bowel disease, and pancreatitis. Seventy participants were in the frequently scanned group while 23,851 participants were in the rarely scanned group. Follow up was done by reviewing electronic medical records for five years. For those in the frequently scanned group, the cancer risk posed by CT scans is great; however, those who are frequently scanned have morbid underlying diagnoses which define the indications for the CT scanning. In this population a large proportion of individuals may die before a radiation-induced cancer would be a factor in their health. The majority of radiation-induced cancers are predicted to result from the rarely scanned group and in this particular study, 47 cases of cancer were predicted overall. The rarely scanned group had a predicted cancer incidence of 36/23,851; the intermediately scanned group had a predicted cancer incidence of 10/1,184; and the frequently scanned group had a predicated cancer incidence of 2/70.

Under normal circumstances, the small risk associated with the lower radiation dose delivered to individuals undergoing CT scanning of a target area for a specific medical need is outweighed by the risk of the medical condition. For whole body CT, which is done for individuals with no suspected medical conditions and those that are at low risk of disease, the radiation-associated risk is not outweighed by any risk related to a medical condition.

The United States Food and Drug Administration (FDA) (2010) has specifically commented it has not approved any CT device for the express purpose of whole body screening in the general population. There are no data demonstrating that whole body CT screening of individuals without symptoms provides a greater probability of benefit than harm, nor is there any scientific study known to be underway to develop such data. Although there are several ongoing investigational studies of the effectiveness of using CT to screen people, the studies are focused on high-risk groups for specific diseases.

Background/Overview

X-ray CT is a technology using an x-ray-sensing unit that rotates around the body, along with a large computer to create cross-sectional images. The images are generated by a computer synthesis of x-ray transmission data obtained in many different directions in a given plane. Whole body CT screening is currently marketed as a preventive or proactive healthcare measure to healthy individuals who have no symptoms or suspicion of disease. A whole body CT examination includes a scan of the head, neck, chest, abdomen and pelvis. In most centers, whole body CT scans are performed without intravenous contrast. Various types of CT scanning are used for whole body imaging, including conventional CT scanning, helical CT scanning, electron-beam CT (EBCT) and multislice CT (MSCT).

Definitions

Computed tomography (CT): An imaging technique that creates multiple cross-sectional images of the body by using special x-rays and computer enhancement to detect disease or abnormalities.

Coronary artery disease: A disease characterized by narrowing or blockage of the blood vessels supplying blood to the heart.

Electron beam computed tomography: A computed tomographic technique using an electron beam, which allows much faster CT scanning procedures.

Helical CT (also known as spiral CT): A CT imaging technique where the scanner takes nonstop images as the individual is moved through the machine. Ordinary CT scanning can take anywhere from 1 to 10 seconds, but the faster spiral CT takes an x-ray in about one-tenth of a second.

Whole body scanning: An imaging technique that proposes the use of computed tomography methods for scanning a person's entire body to detect disease in asymptomatic individuals.

Coding

The following codes for treatments and procedures applicable to this document are included below for informational purposes.  Inclusion or exclusion of a procedure, diagnosis or device code(s) does not constitute or imply member coverage or provider reimbursement policy.  Please refer to the member's contract benefits in effect at the time of service to determine coverage or non-coverage of these services as it applies to an individual member.

 When services are Investigational and Not Medically Necessary:

When the code describes a procedure indicated in the Position Statement section as investigational and not medically necessary.

CPT 
76497Unlisted computed tomography procedure (eg, diagnostic, interventional) [when specified as CT whole body scanning]
  
HCPCS 
S8092Electron beam computed tomography (also known as Ultrafast CT, Cine CT)
  
ICD-9 Diagnosis[For dates of service prior to 10/01/2014]
 All diagnoses
  
ICD-10 Diagnosis[For dates of service on or after10/01/2014]
 All diagnoses
References

Peer Reviewed Publications:

  1. Anderiesz C, Elwood JM, McAvoy BR, Kenny LM. Whole-body computed tomography screening: looking for trouble? Med J Aust. 2004; 181(6):295-296.
  2. Brenner DJ, Elliston CD. Estimated radiation risks potentially associated with full-body CT screening. Radiology. 2004; 232(3):735-738.
  3. Schwartz LM, Woloshin S, Fowler FJ, Welch HG. Enthusiasm for cancer screening in the United States. JAMA. 2004; 291(1):71-78.
  4. Zondervan RL, Hahn PF, Sadow CA, et al. Frequent body CT scanning of young adults: indications, outcomes, and risk for radiation-induced cancer. J Am Coll Radiol. 2011; 8(7):501-507.

Government Agency, Medical Society, and Other Authoritative Publications.

  1. Agency for Healthcare Research and Quality. U.S. Preventive Services Task Force Using Nontraditional Risk Factors in Coronary Heart Disease Risk Assessment: Recommendation statement. 2009 October. Available at: http://www.uspreventiveservicestaskforce.org/uspstf09/riskcoronaryhd/coronaryhdrs.htm. Accessed on September 9, 2013.
  2. American College of Radiology (ACR). Statement on whole body CT screening. 2002. Available at: http://www.acr.org/. Accessed on September 9, 2013.
  3. American Medical Association (AMA). Council on Ethical and Judicial Affairs: Inappropriate medical screening tests. 2005. Available at: http://www.ama-assn.org/ama1/pub/upload/mm/369/ceja_3a05.pdf. Accessed on September 9, 2013.
  4. Centers for Medicare and Medicaid Services. National Coverage Determination: Computed Tomography. NCD #220.1. Effective March 12, 2008. Available at: http://www.cms.hhs.gov/mcd/index_list.asp?list_type=ncd. Accessed on September 9, 2013.
  5. U.S. Food and Drug Administration. Center for Devices and Radiological Health. Computed tomography (CT). 2013. Available at: http://www.fda.gov/Radiation-EmittingProducts/RadiationEmittingProductsandProcedures/MedicalImaging/MedicalX-Rays/ucm115317.htm. Accessed on September 9, 2013.
  6. U.S. Food and Drug Administration. Center for Devices and Radiological Health. Full-Body CT scans - what you need to know. 2010. Available at: http://www.fda.gov/Radiation-EmittingProducts/RadiationEmittingProductsandProcedures/MedicalImaging/MedicalX-Rays/ucm115340.htm. Accessed on September 9, 2013.
Web Sites for Additional Information
  1. National Cancer Institute. Computed Tomography (CT) Scans and Cancer. Available at: http://www.cancer.gov/cancertopics/factsheet/detection/CT. Accessed on September 9, 2013.
Index

Computed Tomography, Electron Beam
Helical CT
High-Speed Computed X-Ray Tomography
Rapid Acquisition X-Ray Computed Tomography
Spiral CT
Ultrafast Computed Tomography

Document History
StatusDateAction
Reviewed11/14/2013Medical Policy & Technology Assessment Committee (MPTAC) review. Updated Rationale, Background/Overview, and References.
Reviewed11/08/2012MPTAC review. Updated Rationale and Background/Overview. Added Web Sites for Additional Information. Title change to "Whole Body Computed Tomography Scanning."
Reviewed11/17/2011MPTAC review. Updated References.
Reviewed11/18/2010MPTAC review. Updated References. No change to Position Statement.
Reviewed02/25/2010MPTAC review. Updated References, removed Web Sites for Additional Information section.
Reviewed02/26/2009MPTAC review. Updated References and Web Sites.
Reviewed02/21/2008MPTAC review. No changes to Position Statement. The phrase "investigational/not medically necessary" was clarified to read "investigational and not medically necessary." This change was approved at the November 29, 2007 MPTAC meeting.
Reviewed03/08/2007MPTAC review. No changes to Position Statement. References updated. 
Reviewed03/23/2006MPTAC review. References updated. 
 11/17/2005Added reference for Centers for Medicare and Medicaid Services (CMS) – National Coverage Determination (NCD).
Revised04/28/2005MPTAC review. Revision based on Pre-merger Anthem and Pre-merger WellPoint Harmonization.
Pre-Merger OrganizationsLast Review DateDocument NumberTitle 
Anthem, Inc.01/29/2004RAD.00001Electron Beam Computed Tomography (EBCT), Whole Body CT Scanning 
WellPoint Health Networks, Inc.12/02/20044.01.16Screening Whole Body CT Scan