|Subject:||Whole Body Computed Tomography Scanning|
|Policy #:||RAD.00037||Current Effective Date:||01/05/2016|
|Status:||Reviewed||Last Review Date:||11/05/2015|
This document addresses the use of various computed tomography (CT) scanning modalities when used to perform whole body scans for general screening. Whole body CT scanning 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 an early screening tool to detect cancer, cardiac disease, and other abnormalities. This document does not address disease-specific CT screening.
Note: Please see the following related documents for additional information:
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 (that is in individuals without signs or symptoms of disease).
Currently, there is no evidence to demonstrate the efficacy of whole body CT screening in the early detection and improved management or clinical outcomes of any disease. CT scanning exposes individuals to potentially harmful levels of radiation; neither the benefits nor the risks of this method of screening have been adequately assessed in clinical trials. Furthermore, there is the potential of false positive findings that could result in unnecessary invasive and noninvasive testing, further compounding the 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 (5 to 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 impetuses for scanning were cancer diagnosis, organ or bone marrow transplant, inflammatory bowel disease, and pancreatitis. A total of 70 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 5 years. For those in the frequently scanned group, the relative risk of cancer incidence posed by CT scans appears elevated (2.2% increased risk); however, those who are frequently scanned also have more serious underlying diagnoses which necessitated the CT scanning. In this more seriously ill population, a large proportion of individuals may die before the time-frame in which a radiation-induced cancer would be most likely to develop (nearly 50% are deceased within a decade). Due to the vast number of participants in the rarely scanned group, the majority of radiation-induced cancers are predicted to result in this population. The rarely scanned group had a predicted cancer incidence of 36/23,851; the intermediately scanned group had a predicted cancer incidence of 10/1184; and the frequently scanned group had a predicated cancer incidence of 2/70. Authors conclude that it is not those frequently scanned that are at the most risk for harm (because the risks outweigh benefits and overall survival is often too short for radiation-induced cancer development), but those who are rarely scanned, perhaps unnecessarily, that are at the most risk. They write that,
Given these observations, the goal of reducing radiation-induced cancer risk from CT becomes one of decreasing the overall number of patients scanned, or conversely, of ensuring that only medically necessary CT scans are performed. Much evidence exists to suggest that up to 20% to 50% of advanced imagining procedures fail to provide information that improves patient welfare and therefore may represent, at least in part, unnecessary imaging services.
There is also risk associated with radiation doses delivered to individuals undergoing CT scanning of a target area for a specific medical need; however, the risk may be outweighed by the risk posed by the medical condition. The diagnostic value, risk and benefits, are well established in the literature for a number of target areas and diseases. Conversely, for whole body CT, which by definition is performed on individuals with no suspected medical conditions (i.e., low risk of disease) the radiation-associated risk is not outweighed by any risk related to a medical condition and as a result poses unnecessary potential harm.
The United States Food and Drug Administration (FDA; 2010) has not approved any CT device for the express purpose of whole body screening in the general population and has explicitly stated that 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.
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, EBCT and MSCT.
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.
Electron beam computed tomography (EBCT): 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.
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.
|76497||Unlisted computed tomography procedure (eg, diagnostic, interventional) [when specified as CT whole body scanning]|
|S8092||Electron beam computed tomography (also known as Ultrafast CT, Cine CT)|
Peer Reviewed Publications:
Government Agency, Medical Society, and Other Authoritative Publications:
|Websites for Additional Information|
Computed Tomography, Electron Beam
High-Speed Computed X-Ray Tomography
Rapid Acquisition X-Ray Computed Tomography
Ultrafast Computed Tomography
|Reviewed||11/05/2015||Medical Policy & Technology Assessment Committee (MPTAC) review. Updated References. Removed ICD-9 codes from Coding section.|
|Reviewed||11/13/2014||MPTAC review. Updated Description/Scope, Rationale, Background/Overview, and References.|
|Reviewed||11/14/2013||MPTAC review. Updated Rationale, Background/Overview, and References.|
|Reviewed||11/08/2012||MPTAC review. Updated Rationale and Background/Overview. Added Web Sites for Additional Information. Title change to "Whole Body Computed Tomography Scanning."|
|Reviewed||11/17/2011||MPTAC review. Updated References.|
|Reviewed||11/18/2010||MPTAC review. Updated References. No change to Position Statement.|
|Reviewed||02/25/2010||MPTAC review. Updated References, removed Web Sites for Additional Information section.|
|Reviewed||02/26/2009||MPTAC review. Updated References and Web Sites.|
|Reviewed||02/21/2008||MPTAC 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.|
|Reviewed||03/08/2007||MPTAC review. No changes to Position Statement. References updated.|
|Reviewed||03/23/2006||MPTAC review. References updated.|
|11/17/2005||Added reference for Centers for Medicare and Medicaid Services (CMS) – National Coverage Determination (NCD).|
|Revised||04/28/2005||MPTAC review. Revision based on Pre-merger Anthem and Pre-merger WellPoint Harmonization.|
|Pre-Merger Organizations||Last Review Date||Document Number||Title|
|Anthem, Inc.||01/29/2004||RAD.00001||Electron Beam Computed Tomography (EBCT), Whole Body CT Scanning|
|WellPoint Health Networks, Inc.||12/02/2004||4.01.16||Screening Whole Body CT Scan|