CAM 60112

Thermography

Category:Radiology   Last Reviewed:February 2019
Department(s):Medical Affairs   Next Review:February 2020
Original Date:March 1996    

Description:
Thermography is a noninvasive imaging technique intended to measure temperature distribution in organs and tissues. The visual display of this temperature information is known as a thermogram. Thermography has been proposed as a diagnostic tool, for treatment planning and for evaluation of treatment effects for a variety of conditions.

For individuals who have an indication for breast cancer screening or diagnosis who receive thermography, the evidence includes diagnostic accuracy studies and systematic reviews. Relevant outcomes are overall survival, disease-specific survival, test accuracy and test validity. Systematic reviews of studies evaluating the accuracy of thermography to screen and/or to diagnose breast cancer found wide ranges of sensitivities and specificities. Studies to date have not demonstrated that thermography is sufficiently accurate to replace or supplement mammography for breast cancer diagnosis. Moreover, there are no studies on the impact of thermography on patient management or health outcomes for patients with breast cancer. The evidence is insufficient to determine the effects of the technology on health outcomes.

For individuals who have musculoskeletal injuries who receive thermography, the evidence includes diagnostic accuracy studies and a systematic review. Relevant outcomes are test accuracy and validity, symptoms and functional outcomes. A systematic review of studies on thermography for diagnosing musculoskeletal injuries has found moderate levels of accuracy compared with other diagnostic imaging tests. This evidence does not permit conclusions whether thermography is sufficiently accurate to replace or supplement standard testing. Moreover, there are no studies on the impact of thermography on patient management or health outcomes for patients with musculoskeletal injuries. The evidence is insufficient to determine the effects of the technology on health outcomes.

For individuals who have miscellaneous conditions (e.g., herpes zoster, pressure ulcers, temporomandibular joint disorder) who receive thermography, the evidence includes diagnostic accuracy studies and a systematic review. Relevant outcomes are test accuracy and validity, symptoms and functional outcomes. There are 1 or 2 preliminary studies each from outside the United States on various miscellaneous potential indications for thermography. Most studies assessed temperature gradients or the association between temperature differences and the clinical condition. Studies have not adequately evaluated the diagnostic accuracy or clinical utility of thermography for any of these conditions. The evidence is insufficient to determine the effects of the technology on health outcomes.

Background
Interpretation of the color patterns is thought to assist in the diagnosis of many disorders such as complex regional pain syndrome (previously known as reflex sympathetic dystrophy), breast cancer, Raynaud phenomenon, digital artery vasospasm in hand-arm vibration syndrome, peripheral nerve damage following trauma, impaired spermatogenesis in infertile men, degree of burns, deep vein thrombosis, gastric cancer, tear-film layer stability in dry-eye syndrome, Frey syndrome, headaches, low back pain, and vertebral subluxation.

Infrared radiation from the skin or organ tissue reveals temperature variations by producing brightly colored patterns on a liquid crystal display. 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. 

Thermography may also assist in treatment planning and procedure guidance by accomplishing the following tasks: identifying restricted areas of perfusion in coronary artery bypass grafting, identifying unstable atherosclerotic plaque, assessing response to methylprednisone in rheumatoid arthritis, and locating high undescended testicles.

Regulatory Status
A number of thermographic devices have been cleared for marketing by the Food and Drug Administration through the 510(k) process. Examples of these devices are shown in Table 1. 

Table 1. Thermography Devices Cleared by the Food and Drug Administration 

Device Name Manufacturer Clearance Date 510(K) No.
Dorex Spectrum 9000MB Thermography System Dorex Nov 2002 K023434
Infrared Sciences Breastscan IR System Infrared Sciences Feb 2004 K032350
Notouch Breastscan Lifesciences Feb 2012 K113259
WoundVision Scout WoundVision Dec 2013 K131596
FirstSense Breast Exam® First Sense Medical Jun 2016 K160573

Policy:
The use of all forms of thermography (temperature gradient studies) is considered INVESTIGATIONAL because the available medical literature indicates thermography to be an ineffective diagnostic technique.

The use of dynamic infrared perfusion imaging (DIRI) is considered INVESTIGATIONAL because of a lack of evidence of its clinical utility.

Policy Guidelines
There is no specific code for skin surface infrared thermography.

CPT 93740 can be used for temperature gradient studies using an intravenous catheter.

Benefit Application
BlueCard®/National Account Issues
State or federal mandates (e.g., FEP) may dictate that all devices approved by the U.S. Food and Drug Administration (FDA) may not be considered investigational. Therefore, FDA-approved devices may only be assessed on the basis of their medical necessity.

Rationale
This evidence review was created in March 1996 and has been updated regularly with searches of the MEDLINE database. The most recent literature review was performed through July 9, 2018. 

Evidence reviews assess whether a medical test is clinically useful. A useful test provides information to make a clinical management decision that improves the net health outcome. That is, the balance of benefits and harms is better when the test is used to manage the condition than when another test or no test is used to manage the condition. 

The first step in assessing a medical test is to formulate the clinical context and purpose of the test. The test must be technically reliable, clinically valid, and clinically useful for that purpose. Evidence reviews assess the evidence on whether a test is clinically valid and clinically useful. Technical reliability is outside the scope of these reviews, and credible information on technical reliability is available from other sources. 

Breast Cancer 
Clinical Context and Test Purpose 
The purpose of using thermography in patients who are suspected of having breast cancer is to inform a decision whether to proceed to appropriate treatment or not.

The question addressed in this portion of the evidence review is: Does thermography when used to screen or diagnose breast cancer improve the net health outcome compared with standard mammographic techniques? Specifically, does the use of thermography improve diagnostic accuracy compared with standard screening mammography methods and is this increase in accuracy likely to improve health outcomes by leading to earlier diagnosis and treatment?

The following PICOTS were used to select literature to inform this review. 

Patients 
The relevant populations of interest are asymptomatic individuals being screened for breast cancer or individuals undergoing testing to diagnose breast cancer.

Interventions
The intervention of interest is thermography. 

Comparators 
The following test is currently being used to make decisions about breast cancer diagnosis: mammography. 

Outcomes 
The outcome of interest for diagnostic accuracy is test validity (ie, sensitivity, specificity). The primary outcomes of interest for clinical utility are overall survival and breast cancer-specific survival rates. 

The potential beneficial outcomes of primary interest in the case of a true-negative would be the avoidance of unnecessary surgery and its associated consequences (eg, morbidity, mortality, resource utilization, patient anxiety). The potential harms from a false-positive could be inappropriate assessment and improper management of patients with breast malignancies, which could result in the following: inappropriate surgical decisions, high frequency of unnecessary further testing, and unnecessary patient anxiety. The potential harms from a false-negative could be a determination that the patient does not have malignancy, which would lead to a delay in surgery and tumor diagnosis. 

Timing 
The timing for routine screening can be guided by national guidelines on breast cancer screening. The timing for diagnosis would be after an initial screening test or clinical examination. 

Setting 
The test would be performed in an outpatient setting. 

Technically Reliable 
Assessment of technical reliability focuses on specific tests and operators and requires review of unpublished and often proprietary information. Review of specific tests, operators, and unpublished data are outside the scope of this evidence review and alternative sources exist. This evidence review focuses on the clinical validity and clinical utility. 

Clinically Valid 
A test must detect the presence or absence of a condition, the risk of developing a condition in the future, or treatment response (beneficial or adverse).

Systematic Reviews 
Several systematic reviews of the published literature on the diagnostic accuracy of thermography were identified. A systematic review by Vreugdenburg et al (2013) identified 8 studies on thermography for diagnosis of breast cancer that included a valid reference standard (eg, biopsy with histopathologic confirmation).1, Six of the 8 studies, with sample sizes between 29 and 769 patients, included women scheduled for a biopsy. Thermography accuracy varied highly.

Sensitivity in the individual studies ranged from 25% to 97%, and specificity ranged from 12% to 85%. Study findings were not pooled. 

Previously, a systematic review by Fitzgerald and Berentson-Shaw (2012) identified 6 studies, one using thermography for breast cancer screening and the others using thermography to diagnose breast cancer among symptomatic women or those with a positive mammogram.2, In the screening study, more than 10,000 women were invited to participate, and sample sizes in the diagnosis studies ranged from 63 to 2625 subjects. The screening study found that, compared with mammography, thermography had a sensitivity of 25% and a specificity of 74%. In the diagnostic studies, which all used histology as the reference standard, sensitivity ranged from 25% to 97%, and specificity ranged from 12% to 85%. 

Diagnostic Studies 
Several studies have been published since the systematic reviews. Omranipour et al (2016) compared the accuracy of thermography and mammography in 132 patients in Iran who had breast lesions and were candidates for breast biopsy.3, The final pathologic result, which was used as the reference standard, indicated that there were 45 benign lesions and 87 malignant lesions. The diagnostic accuracy of thermography (67.7%) was lower than for mammography (76.9%; p values not reported). While the sensitivities of the 2 tests were similar (80.5% for mammography vs 81.6% for thermography), the specificity was higher for mammography (73.3%) than for thermography (57.8%). Both the positive and negative predictive values were lower with thermography than with mammography. The positive and negative predictive values were 85.4% and 66.0% for mammography, and 78.9% and 61.9% for thermography, respectively. 

Rassiwala et al (2014) in India reported on 1008 women being screened for breast cancer.4, Following breast thermography, 959 women were classified as normal (temperature gradient, <2.5), 8 as abnormal (temperature gradient range, 2.5-3), and 41 as potentially having breast cancer (temperature gradient, ≥3). Women who tested positive on thermography (n=49) underwent clinical, radiologic, and histopathologic examination. Forty-one of 49 women with positive thermograms were found to have breast cancer. The authors calculated the sensitivity of thermography to be 97.6% and the specificity to be 99.17%. The false-negative rate could not be accurately calculated because only women who had normal thermograms had a clinical examination and did not undergo radiologic reference tests. 

Clinically Useful 
A test is clinically useful if the use of the results informs management decisions that improve the net health outcome of care. The net health outcome can be improved if patients receive correct therapy, or more effective therapy, or avoid unnecessary therapy, or avoid unnecessary testing. 

Direct Evidence 
Direct evidence of clinical utility is provided by studies that have compared health outcomes for patients managed with and without the test. Because these are intervention studies, the preferred evidence would be from randomized controlled trials. 

No studies have demonstrated how the results of thermography could be used to enhance the management of breast cancer patients in a manner that would improve their health outcomes. 

Chain of Evidence
Indirect evidence on clinical utility rests on clinical validity. If the evidence is insufficient to demonstrate test performance, no inferences can be made about clinical utility. 

It is not possible to construct a chain of evidence for clinical utility due to the lack of sufficient evidence that the diagnostic accuracy of thermography is at least as high as mammographic techniques for breast cancer screening and diagnosis. 

Section Summary: Breast Cancer 
Systematic reviews of studies evaluating the accuracy of thermography for diagnosing breast cancer found wide ranges of sensitivities and specificities and, where data are available, relatively low diagnostic accuracy compared with mammography. To date, no study has demonstrated that thermography is sufficiently accurate to replace or supplement mammography for breast cancer diagnosis. Moreover, there are no studies on the impact of thermography on patient management or health outcomes for patients with breast cancer. 

Musculoskeletal Injuries 
Clinical Context and Test Purpose 
The purpose of using thermography in patients who have a musculoskeletal injury is to inform a decision whether to proceed to appropriate treatment or not. 

The question addressed in this portion of the evidence review is: Does thermography when used to diagnose musculoskeletal injuries, improve the net health outcome compared with standard approaches. Specifically, does the use of thermography improve diagnostic accuracy compared with standard approaches (eg, clinical examination, imaging with radiography or magnetic resonance imaging), and is this degree of increased accuracy likely to improve health outcomes by leading to earlier diagnosis and treatment?

The following PICOTS were used to select literature to inform this review. 

Patients 
The relevant population of interest is individuals with musculoskeletal pain. Interventions

Comparators 
The following tests and practices are currently being used to make decisions about musculoskeletal injuries: standard care without imaging and other forms of imaging (eg, with radiography, magnetic resonance imaging). 

Outcomes 
The outcomes of interest for diagnostic accuracy include test accuracy and test validity (ie, sensitivity, specificity). The primary outcomes of interest for clinical utility are a reduction in pain symptoms and improvement in functional ability. 

Timing 
The timing would be following a musculoskeletal injury. 

Setting
The test would be performed in an outpatient setting. 

Technically Reliable 
Assessment of technical reliability focuses on specific tests and operators and requires review of unpublished and often proprietary information. Review of specific tests, operators, and unpublished data are outside the scope of this evidence review and alternative sources exist. This evidence review focuses on the clinical validity and clinical utility. 

Clinically Valid 
A test must detect the presence or absence of a condition, the risk of developing a condition in the future, or treatment response (beneficial or adverse).

A systematic review by Sanchis-Sanchez et al (2014) evaluated the literature on thermography for diagnosing musculoskeletal injuries.5, To be included in the review, studies had to report on diagnostic accuracy and use findings from diagnostic imaging tests (eg, radiographs, computed tomography, magnetic resonance imaging, or ultrasound) as the reference standard. Six studies met the eligibility criteria; 3 included patients with suspected stress fractures and the remainder addressed other musculoskeletal injuries. Sample sizes of individual studies ranged from 17 to 164 patients. In the 3 studies on stress fracture, sensitivity ranged from 45% to 82% and specificity from 83% to 100%. Pooled specificity was 69% (95% confidence interval, 49% to 85%); data on sensitivity were not pooled. 

Clinically Useful 
A test is clinically useful if the use of the results informs management decisions that improve the net health outcome of care. The net health outcome can be improved if patients receive correct therapy, or more effective therapy, or avoid unnecessary therapy, or avoid unnecessary testing. 

Direct Evidence 
Direct evidence of clinical utility is provided by studies that have compared health outcomes for patients managed with and without the test. Because these are intervention studies, the preferred evidence would be from randomized controlled trials. 

No studies have been published that evaluate health outcomes in patients with musculoskeletal injuries who were managed with and without thermography. 

Chain of Evidence 
Indirect evidence on clinical utility rests on clinical validity. If the evidence is insufficient to demonstrate test performance, no inferences can be made about clinical utility. 

It is not possible to construct a chain of evidence for clinical utility due to the lack of sufficient evidence that the diagnostic accuracy of thermography is at least as high as standard techniques for diagnosing musculoskeletal injuries. 

Section Summary: Musculoskeletal Injuries 
A systematic review of studies on thermography for diagnosing musculoskeletal injuries found moderate levels of accuracy compared with other diagnostic imaging tests. There was a lack of a consistent reference standard. This evidence does not permit conclusions as to whether thermography is sufficiently accurate to replace or supplement standard testing. Moreover, there are no studies on the impact of thermography on patient management or health outcomes for patients with musculoskeletal injuries.

Miscellaneous Conditions 
A number of studies have assessed a range of potential thermography applications. To date, no study has examined the impact of thermography on patient management decisions or health outcomes. Examples of other studies on thermography, mainly conducted outside of the United States, include those evaluating the association between thermographic findings and post-herpetic neuralgia in patients with herpes zoster,6,7, surgical site healing in patients who underwent knee replacements,8, predicting pressure ulcers9, and pressure ulcer healing,10, posttreatment pain in patients with coccygodynia,11, evaluation of allergic conjunctivitis,12, evaluation of burn depth,13, identifying patients with temporomandibular disorder,14, detecting cervical lymph node metastasis from oral cavity cancer,15, monitoring lesions in patients with juvenile localized scleroderma,16, and measuring disease activity in patients with rheumatoid arthritis.17,

Several studies evaluating the clinical validity of thermography to assess potential complications of the diabetic foot have been conducted. Thermographic images of nondiabetic feet, nonulcerated diabetic feet and ulcerated diabetic feet have been compared.18,19,20, Another study used thermography to diagnose infections in patients admitted with diabetic foot complications.21, While these studies reported temperature differences between the different feet, none investigated clinical utility, in which health outcomes were compared in patients who were managed with and without thermography results. 

Section Summary: Miscellaneous Conditions 
For most of these potential indications, there are 1 or 2 preliminary studies on each of the indications. Several studies evaluated the clinical validity of thermography in assessing diabetic foot and related complications. For all indications, the studies described temperature gradients or the association between temperature differences and the clinical condition. Due to the small number of studies for each indication, the diagnostic accuracy could not adequately be evaluated. The clinical utility of thermography for these miscellaneous conditions was not investigated in any study. 

Summary of Evidence 
For individuals who have an indication for breast cancer screening or diagnosis who receive thermography, the evidence includes diagnostic accuracy studies and systematic reviews. Relevant outcomes are overall survival, disease-specific survival, and test validity. Using histopathologic findings as the reference standard, a series of systematic reviews of studies have evaluated the accuracy of thermography to screen and/or diagnose breast cancer and reported wide ranges of sensitivities and specificities. To date, no study has demonstrated whether thermography is sufficiently accurate to replace or supplement mammography for breast cancer diagnosis. Moreover, there are no studies on the impact of thermography on patient management or health outcomes for patients with breast cancer. The evidence is insufficient to determine the effects of the technology on health outcomes. 

For individuals who have musculoskeletal injuries who receive thermography, the evidence includes diagnostic accuracy studies and a systematic review. Relevant outcomes are test validity, symptoms, and functional outcomes. A systematic review of studies on thermography for diagnosing musculoskeletal injuries found moderate levels of accuracy compared with other diagnostic imaging tests. There is a lack of a consistent reference standard. This evidence does not permit conclusions as to whether thermography is sufficiently accurate to replace or supplement standard testing. Moreover, there are no studies on the impact of thermography on patient management or health outcomes for patients with musculoskeletal injuries. The evidence is insufficient to determine the effects of the technology on health outcomes. 

For individuals who have miscellaneous conditions (eg, herpes zoster, pressure ulcers, temporomandibular joint disorder, diabetic foot) who receive thermography, the evidence includes diagnostic accuracy studies. Relevant outcomes are test validity, symptoms, and functional outcomes. There are 1 or 2 preliminary studies on each of these potential indications for thermography. Most studies assessed temperature gradients or the association between temperature differences and the clinical condition. Due to the small number of studies for each indication, diagnostic accuracy could not adequately be evaluated. The clinical utility of thermography for any of these miscellaneous conditions has not been investigated in studies considered. The evidence is insufficient to determine the effects of the technology on health outcomes.

Practice Guidelines and Position Statements European Society of Breast Imaging et al
A position paper by the European Society of Breast Imaging (2017) and 30 other national breast radiology bodies on screening for breast cancer stated that "screening with thermography or other optical tools as alternatives to mammography is discouraged."22,

American College of Radiology 
An American College of Radiology statement (2013; republished 2016) concluded that there is insufficient evidence to support the use of thermography for breast cancer screening.23,

National Comprehensive Cancer Network 
National Comprehensive Cancer Network guidelines on breast cancer screening and diagnosis (v.2.2018) states that "Current evidence does not support the routine use of thermography or ductal lavage as screening procedures." 24,

U.S. Preventive Services Task Force Recommendations 
The U.S. Preventive Services Task Force (2016) recommendations on breast cancer screening do not mention thermography.25,

Ongoing and Unpublished Clinical Trials 
Some currently unpublished trials that might influence this review are listed in Table 2.

Table 2. Summary of Key Trials

 

NCT No.

Trial Name

Planned Enrollment

Completion Date

Ongoing

 

 

 

NCT02705443

Early Identification of Suspected Deep Tissue Injury (sDTI) Utilizing Long-Wave Thermographic Imaging (LWIT)

60

Jun 2017 (ongoing)

NCT03254095

Thermal and Biomechanical Characterization of Diabetic Foot Patients, Predictors of Skin Temperature, Barefoot Plantar Pressure and Ulceration 

100 

Sep 2018 

NCT03089463 

Foot Assessment in People with Diabetes: A Quantitative Diagnostic Approach 

153 

Oct 2018 

 

NCT: national clinical trial.  

References:

  1. Vreugdenburg TD, Willis CD, Mundy L, et al. A systematic review of elastography, electrical impedance scanning, and digital infrared thermography for breast cancer screening and diagnosis. Breast Cancer Res Treat. Feb 2013;137(3):665-676. PMID 23288346 
  2. Fitzgerald A, Berentson-Shaw J. Thermography as a screening and diagnostic tool: a systematic review. N Z Med J. Mar 9 2012;125(1351):80-91. PMID 22426613 
  3. Omranipour R, Kazemian A, Alipour S, et al. Comparison of the accuracy of thermography and mammography in the detection of breast cancer. Breast Care (Basel). Aug 2016;11(4):260-264. PMID 27721713 
  4. Rassiwala M, Mathur P, Mathur R, et al. Evaluation of digital infra-red thermal imaging as an adjunctive screening method for breast carcinoma: a pilot study. Int J Surg. Dec 2014;12(12):1439-1443. PMID 25448668 
  5. Sanchis-Sanchez E, Vergara-Hernandez C, Cibrian RM, et al. Infrared thermal imaging in the diagnosis of musculoskeletal injuries: a systematic review and meta-analysis. AJR Am J Roentgenol. Oct 2014;203(4):875-882. PMID 25247955 
  6. Han SS, Jung CH, Lee SC, et al. Does skin temperature difference as measured by infrared thermography within 6 months of acute herpes zoster infection correlate with pain level? Skin Res Technol. May 2010;16(2):198-201. PMID 20456100 
  7. Park J, Jang WS, Park KY, et al. Thermography as a predictor of postherpetic neuralgia in acute herpes zoster patients: a preliminary study. Skin Res Technol. Feb 2012;18(1):88-93. PMID 21605168 
  8. Romano CL, Logoluso N, Dell'Oro F, et al. Telethermographic findings after uncomplicated and septic total knee replacement. Knee. Jun 2012;19(3):193-197. PMID 21441031 
  9. Oliveira AL, Moore Z, T OC, et al. Accuracy of ultrasound, thermography and subepidermal moisture in predicting pressure ulcers: a systematic review. J Wound Care. May 02 2017;26(5):199-215. PMID 28475447 
  10. Nakagami G, Sanada H, Iizaka S, et al. Predicting delayed pressure ulcer healing using thermography: a prospective cohort study. J Wound Care. Nov 2010;19(11):465-466, 468, 470 passim. PMID 21135794 
  11. Wu CL, Yu KL, Chuang HY, et al. The application of infrared thermography in the assessment of patients with coccygodynia before and after manual therapy combined with diathermy. J Manipulative Physiol Ther. May 2009;32(4):287-293. PMID 19447265
  12. Hara Y, Shiraishi A, Yamaguchi M, et al. Evaluation of allergic conjunctivitis by thermography. Ophthalmic Res. Mar 5 2014;51(3):161-166. PMID 24603108 
  13. Singer AJ, Relan P, Beto L, et al. Infrared thermal imaging has the potential to reduce unnecessary surgery and delays to necessary surgery in burn patients. J Burn Care Res. Nov/Dec 2016;37(6):350-355. PMID 26720102 
  14. Wozniak K, Szyszka-Sommerfeld L, Trybek G, et al. Assessment of the sensitivity, specificity, and accuracy of thermography in identifying patients with TMD. Med Sci Monit. May 23 2015;21:1485-1493. PMID 26002613 
  15. Dong F, Tao C, Wu J, et al. Detection of cervical lymph node metastasis from oral cavity cancer using a non- radiating, noninvasive digital infrared thermal imaging system. Sci Rep. May 8 2018;8(1):7219. PMID 29739969 
  16. Agazzi A, Fadanelli G, Vittadello F, et al. Reliability of LoSCAT score for activity and tissue damage assessment in a large cohort of patients with Juvenile Localized Scleroderma. Pediatr Rheumatol Online J. Jun 18 2018;16(1):37. PMID 29914516 
  17. Jones B, Hassan I, Tsuyuki RT, et al. Hot joints: myth or reality? A thermographic joint assessment of inflammatory arthritis patients. Clin Rheumatol. Apr 20 2018. PMID 29679167 
  18. Gatt A, Falzon O, Cassar K, et al. The application of medical thermography to discriminate neuroischemic toe ulceration in the diabetic foot. Int J Low Extrem Wounds. Jun 2018;17(2):102-105. PMID 29947290 
  19. Gatt A, Falzon O, Cassar K, et al. Establishing differences in thermographic patterns between the various complications in diabetic foot disease. Int J Endocrinol. 2018;2018:9808295. PMID 29721019 
  20. Balbinot LF, Robinson CC, Achaval M, et al. Repeatability of infrared plantar thermography in diabetes patients: a pilot study. J Diabetes Sci Technol. Sep 2013;7(5):1130-1137. PMID 24124938 
  21. Hazenberg CE, van Netten JJ, van Baal SG, et al. Assessment of signs of foot infection in diabetes patients using photographic foot imaging and infrared thermography. Diabetes Technol Ther. Jun 2014;16(6):370-377. PMID 24690146
  22. Sardanelli F, Aase HS, Alvarez M, et al. Position paper on screening for breast cancer by the European Society of Breast Imaging (EUSOBI) and 30 national breast radiology bodies from Austria, Belgium, Bosnia and Herzegovina, Bulgaria, Croatia, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, Ireland, Italy, Israel, Lithuania, Moldova, The Netherlands, Norway, Poland, Portugal, Romania, Serbia, Slovakia, Spain, Sweden, Switzerland and Turkey. Eur Radiol. Jul 2017;27(7):2737-2743. PMID 27807699
  23. Mainiero MB, Lourenco A, Mahoney MC, et al. ACR Appropriateness Criteria breast cancer screening. J Am Coll Radiol. Nov 2016;13(11s):R45-r49. PMID 27814813 
  24. National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines in Oncology: Breast Cancer Screening and Diagnosis. Version 2.2018. 2018; https://www.nccn.org/professionals/physician_gls/pdf/breast- screening.pdf. Accessed July 19, 2018. 
  25. U.S. Preventive Services Task Force. Breast Cancer: Screening. 2016; http://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/breast-cancer- screening1. Accessed July 19, 2018. 
  26. Centers for Medicare & Medicaid Services (CMS). National Coverage Determination for Thermography (220.11). 1992; https://www.cms.gov/medicare-coverage-database/details/ncd-details.aspx? NCDId=164&ncdver=1&DocID=220.11&SearchType=Advanced&bc=IAAAABAAAAAA&. Accessed July 19, 2018.

Coding Section

Codes Number Description
CPT  93740  Temperature Gradient Studies 
  93799 Unlisted cardiovascular service or procedure
HCPCS   No Code
ICD-10-CM   Investigational for all diagnoses
ICD-10-PCS   ICD-10-PCS codes are only used for inpatient services.
  4A0ZXKZ Measurement of Temperature, External Approach
Type of Service Radiology  
Place of Service Inpatient/Outpatient/Physician's Office  

Procedure and diagnosis codes on Medical Policy documents are included only as a general reference tool for each policy. They may not be all-inclusive.

This medical policy was developed through consideration of peer-reviewed medical literature generally recognized by the relevant medical community, U.S. FDA approval status, nationally accepted standards of medical practice and accepted standards of medical practice in this community, Blue Cross and Blue Shield Association technology assessment program (TEC) and other non-affiliated technology evaluation centers, reference to federal regulations, other plan medical policies and accredited national guidelines.

"Current Procedural Terminology© American Medical Association.  All Rights Reserved" 

History From 2014 Forward     

02/04/2019 

Annual review, no change to policy intent. Updating background, guidelines, coding, rationale and references. 

02/27/2018 

Annual review, no change to policy intent. Updating regulatory status, rationale and references. 

02/03/2017 

Annual review, no change to policy intent. Updating background, description, rationale and references. 

02/02/2016 

Annual review, no change to policy intent. Updating background, description, rationale and references. 

02/18/2015 

Annual review, no change to policy intent. Updated guidelines, rationale and references. Added coding.

02/5/2014

Annual Review. Updated rationale and references. Nochange to policy intent.


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