Subject:
Whole-Body CT Screening
Description:
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IMPORTANT NOTE:
The purpose of this policy is to provide general information applicable to the administration of health benefits that Horizon Blue Cross Blue Shield of New Jersey and Horizon Healthcare of New Jersey, Inc. (collectively “Horizon BCBSNJ”) insures or administers. If the member’s contract benefits differ from the medical policy, the contract prevails. Although a service, supply or procedure may be medically necessary, it may be subject to limitations and/or exclusions under a member’s benefit plan. If a service, supply or procedure is not covered and the member proceeds to obtain the service, supply or procedure, the member may be responsible for the cost. Decisions regarding treatment and treatment plans are the responsibility of the physician. This policy is not intended to direct the course of clinical care a physician provides to a member, and it does not replace a physician’s independent professional clinical judgment or duty to exercise special knowledge and skill in the treatment of Horizon BCBSNJ members. Horizon BCBSNJ is not responsible for, does not provide, and does not hold itself out as a provider of medical care. The physician remains responsible for the quality and type of health care services provided to a Horizon BCBSNJ member.
Horizon BCBSNJ medical policies do not constitute medical advice, authorization, certification, approval, explanation of benefits, offer of coverage, contract or guarantee of payment.
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This policy addresses whole-body computed tomography (CT) scanning or whole-body CT screening as a potential preventive measure for individuals who have no signs or symptoms of disease.
Background
Whole-body computed tomography (CT) scans, which encompass the body from the neck to the pelvis, have been proposed as a general screening test for diseases of the thyroid (i.e., cancer), lungs (i.e., lung cancer), heart (i.e., cardiovascular disease [CVD]), and abdominal and pelvic organs (cancer, CVD). Often the test is marketed directly to the patient and is offered through mobile CT scanners that travel from community to community.
Policy:
(NOTE: For Medicare Advantage, please refer to the Medicare Coverage Section below for coverage guidance.)
Whole-body computed tomography (CT) scans as a screening test is considered investigational.
Medicare Coverage:
There is no National Coverage Determination (NCD). In the absence of an NCD, coverage decisions are left to the discretion of Local Medicare Carriers. Novitas Solutions, Inc, the Local Medicare Carrier for jurisdiction JL, has not issued a determination for this service. Therefore, Medicare Advantage Products will follow the Horizon BCBSNJ Medical Policy.
Medicaid Coverage:
For members enrolled in Medicaid and NJ FamilyCare plans, Horizon BCBSNJ applies the above medical policy.
FIDE SNP:
For members enrolled in a Fully Integrated Dual Eligible Special Needs Plan (FIDE-SNP): (1) to the extent the service is covered under the Medicare portion of the member’s benefit package, the above Medicare Coverage statement applies; and (2) to the extent the service is not covered under the Medicare portion of the member’s benefit package, the above Medicaid Coverage statement applies.
[RATIONALE: Literature searches using the PubMed database through May 10, 2016 have identified a single controlled trial on whole-body computed tomography (CT) scans. In 2007, Obuchowski et al. reported a small (50 subjects) randomized trial of whole-body screening (vs. no screening for 3 years) to determine the feasibility of a larger scale study. (1) Ninety percent of the subjects were reported to be compliant with follow-up at 2 years. Images were interpreted independently by 6 radiologists from 2 institutions. Based on one interpretation, 16 (64%) subjects in the screening group had abnormal findings, but no cancers were detected. A second interpretation showed a similar rate of abnormal findings, although abnormalities were not in the exact same group of 16 subjects. On average, medical costs were twice as high for screened subjects. The authors concluded that a full-scale randomized controlled trial (RCT) of whole-body screening will need to account for the large variability in interpretation of the images, the high rate of incidental findings, and the low prevalence of cancers.
Also identified were 2 retrospective reviews of findings/recommendations from 982 and 1,192 whole-body CT screenings. (2, 3) Both studies observed a strong association between age of the patient and the number of findings and recommendations. Actionable findings ranged from 22.5% of subjects younger than 40 years of age to 80% of patients older than or equal to 80 years of age (2); follow-up imaging was the most common recommendation. (3)
Summary
Evidence has not changed substantially since a 2003 review that concluded “no published studies demonstrate that these procedures reduce morbidity or mortality when used to screen healthy, asymptomatic patients.” (4) Moreover, the radiation dose of the computed tomography (CT) scan itself could lead to an excess lifetime risk of fatal cancer and that radiation dose and associate risk should be included as fundamental parameters for investigating the outcomes of a CT-based screening program. (5) Evidence reviewed in a 2010 report from the Canadian Health Services Research Foundation indicates that whole-body CT screening uses 500 to 1,000 times the radiation levels of a routine chest x-ray, without any demonstrated positive effects on life expectancy. (6) The current literature does not support an improvement in health outcomes with whole-body CT screening. Therefore, this procedure is considered investigational.
Practice Guidelines and Position Statements
The American College of Radiology has posted the following statement regarding whole-body computed tomography (CT) scanning (7):
“The American College of Radiology (ACR) recognizes that an increasing number of computed tomography (CT) screening examinations are being performed in the United States. Much CT screening is targeted at specific diseases, such as lung scanning for cancer in current and former smokers, coronary artery calcium scoring as a predictor of cardiac events, and CT colonography (virtual colonoscopy) for colon cancer. Early data suggest that these targeted examinations may be clinically valid. Large, prospective, multicenter trials are currently under way or in the planning phase to evaluate whether these screening exams reduce the rate of mortality. 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. The ACR will continue to monitor scientific studies concerning these procedures.”
Information from the U.S. Food and Drug Administration (FDA) (12) indicates that recommendations from the U.S. Preventive Services Task Force and the American Medical Association have been added to those of the American College of Radiology, the American College of Cardiology/American Heart Association, the American Association of Physicists in Medicine, and the Health Physics Society, all of whom do not recommend CT screening. The FDA has published the following information on whole-body CT scanning:
“At this time the Food and Drug Administration (FDA) knows of no scientific evidence demonstrating that whole-body scanning of individuals without symptoms provides more benefit than harm to people being screened.”
- “Whole-body CT screening has not been demonstrated to meet generally accepted criteria for an effective screening procedure.
- Medical professional societies have not endorsed whole-body CT scanning for individuals without symptoms.
- CT screening of high-risk individuals for specific diseases such as lung cancer or colon cancer is currently being studied.
- The radiation from a CT scan may be associated with a very small increase in the possibility of developing cancer later in a person's life.”]
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Horizon BCBSNJ Medical Policy Development Process:
This Horizon BCBSNJ Medical Policy (the “Medical Policy”) has been developed by Horizon BCBSNJ’s Medical Policy Committee (the “Committee”) consistent with generally accepted standards of medical practice, and reflects Horizon BCBSNJ’s view of the subject health care services, supplies or procedures, and in what circumstances they are deemed to be medically necessary or experimental/ investigational in nature. This Medical Policy also considers whether and to what degree the subject health care services, supplies or procedures are clinically appropriate, in terms of type, frequency, extent, site and duration and if they are considered effective for the illnesses, injuries or diseases discussed. Where relevant, this Medical Policy considers whether the subject health care services, supplies or procedures are being requested primarily for the convenience of the covered person or the health care provider. It may also consider whether the services, supplies or procedures are more costly than an alternative service or sequence of services, supplies or procedures that are at least as likely to produce equivalent therapeutic or diagnostic results as to the diagnosis or treatment of the relevant illness, injury or disease. In reaching its conclusion regarding what it considers to be the generally accepted standards of medical practice, the Committee reviews and considers the following: all credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community, physician and health care provider specialty society recommendations, the views of physicians and health care providers practicing in relevant clinical areas (including, but not limited to, the prevailing opinion within the appropriate specialty) and any other relevant factor as determined by applicable State and Federal laws and regulations.
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Index:
Whole-Body CT Screening
CT Scanning, Whole-Body
Entire Body CT Scanning
Full Body CT Scanning
Total Body CT Scanning
References:
1. Obuchowski NA, Holden D, Modic MT et al. Total-body screening: preliminary results of a pilot randomized controlled trial. J Am Coll Radiol 2007; 4(9-Jan):604-11.
2. Obuchowski N, Modic MT. Total body screening: predicting actionable findings. Acad Radio 2006; 13(4):480-5.
3. Furtado CD, Aguirre DA, Sirlin CB et al. Whole-body CT screening: spectrum of findings and recommendations in 1192 patients. Radiology 2005; 237(2):385-94.
4. Dixon GD. Computed tomography for screening purposes: a review of the literature--2003. Mo Med 2003; 100(2):140-4.
5. Buls N, de Mey J, Covens P et al. Health screening with CT: prospective assessment of radiation dose and associated detriment. JBR-BTR 2005; 88(1):12-16.
6. Canadian Health Services Research Foundation. Myth: whole-body screening is an effective way to detect hidden cancers. J Health Serv Res Policy 2010; 15(2-Jan):118-9.
7. American College of Radiology. ACR Statement on Whole Body CT Screening. 2002. (current version as of 07/01/2015) Available online at: http://www.acr.org/About-Us/Media-Center/Position-Statements/Position-Statements-Folder/ACR-Statement-on-Whole-Body-CT-Screening. Last accessed July 1, 2015.
8. 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.
9. Sierink JC, Saltzherr TP, Reitsma JB, et al. Systematic review and meta-analysis of immediate total-body computed tomography compared with selective radiological imaging of injured patients. Br J Surg 2012; 99 Suppl 1:52-58.
10. UpToDate. Full body CT scan for screening. Literature review current through February 2014.
11. UpToDate. Radiation-related risk of imaging studies. Literature review current through May 2016; topic last updated June 19, 2015.
12. U.S. Food and Drug Adminstration. Full-Body CT Scans - What You Need to Know. Available at http://www.fda.gov/Radiation-EmittingProducts/RadiationEmittingProductsandProcedures/MedicalImaging/MedicalX-Rays/ucm115340.htm
13. Lee CI, Elmore JG. Radiation-related risk of imaging studies. In: UpToDate, Aronson MD, Libman H (Eds), UpToDate, Waltham, MA. (Accessed on May 7, 2017.)
14. Lee CI, Elmore JG. Radiation-related risk of imaging studies. In: UpToDate, Aronson MD, Libman H (Eds), UpToDate, Waltham, MA. (Accessed on March 29, 2018.)
Codes:
(The list of codes is not intended to be all-inclusive and is included below for informational purposes only. Inclusion or exclusion of a procedure, diagnosis, drug or device code(s) does not constitute or imply authorization, certification, approval, offer of coverage or guarantee of payment.)
CPT*
HCPCS
* CPT only copyright 2020 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.
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Medical policies can be highly technical and are designed for use by the Horizon BCBSNJ professional staff in making coverage determinations. Members referring to this policy should discuss it with their treating physician, and should refer to their specific benefit plan for the terms, conditions, limitations and exclusions of their coverage.
The Horizon BCBSNJ Medical Policy Manual is proprietary. It is to be used only as authorized by Horizon BCBSNJ and its affiliates. The contents of this Medical Policy are not to be copied, reproduced or circulated to other parties without the express written consent of Horizon BCBSNJ. The contents of this Medical Policy may be updated or changed without notice, unless otherwise required by law and/or regulation. However, benefit determinations are made in the context of medical policies existing at the time of the decision and are not subject to later revision as the result of a change in medical policy
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