Medical Policy: 06.01.31
Original Effective Date: September 2013
Reviewed: July 2015
Revised: July 2015
Benefit determinations are based on the applicable contract language in effect at the time the
services were rendered. Exclusions, limitations or exceptions may apply. Benefits may vary
based on contract, and individual member benefits must be verified. Wellmark determines medical
necessity only if the benefit exists and no contract exclusions are applicable. This medical
policy may not apply to FEP. Benefits are determined by the Federal Employee Program.
This Medical Policy document describes the status of medical technology at the time the document
was developed. Since that time, new technology may have emerged or new medical literature may
have been published. This Medical Policy will be reviewed regularly and be updated as scientific
and medical literature becomes available.
Body composition measurement tools measure the presence of water, minerals, protein, and fat in the body. These measurement tools have been proposed as a method to evaluate patients' nutrition, growth and disease. Body composition measurement has been used as a tool in the research setting in studies evaluating normal human growth and development, as well as disease processes and treatments. However, current peer-reviewed, scientific literature does not define what specific role, if any, body composition measurement has in patient management, predicting health risk and whether it improves clinical outcomes. Methods of measuring body composition that have been proposed include:
anthropometry (i.e., measuring skinfold thickness[SKF])
circumference measures, including waist-to-hip ratio (WHR)
bioelectrical impedance analysis (BIA)
air displacement plethysmography (ADP)
computed tomography (CT)
magnetic resonance imaging (MRI)
whole body dual-energy x-ray absorptiometry (DEXA or DXA)
Dual-energy x-ray absorptiometry (DEXA or DXA) scanning was primarily developed for the diagnosis of osteoporosis and was initially applied to clinically important sites of the lumbar spine, femoral neck, and forearm. With whole body DEXA/DXA scanning, a controlled x-ray beam scans the entire body for determination of bone mineral content, body fat and lean tissue mass. The comprehensive view of body composition provided by DEXA/DXA is purported to be the clinical method of choice for assessing body composition by its supporters because of its relatively low dose of ionizing radiation, speed, and ease of application. Its proposed utility includes determining appropriate nutritional support during disease progression and monitoring response to therapeutic interventions.
The use of DEXA/DXA in the evaluation of body composition is becoming more widespread. It can be easily used in clinical studies and in various health care delivery locations. One disadvantage is in regards to follow up. Follow up of a patient requires the use of the same DEXA/DXA scanner and caution is needed when comparing results from different scanners.
DEXA/DXA has emerged as a new reference for body composition studies, replacing underwater weighing. While DEXA/DXA scans have become a valued research tool, it is unclear how information regarding body composition could be used in the active medical management of the patient to alter treatment decisions or improve health outcomes. No studies have been identified in the literature in which DEXA/DXA body composition measurements were actively used in patient management, and studies have not reported data demonstrating the impact of body composition assessment on health outcomes. Therefore, the technique is considered investigational.
Practice Guideline and Position Statements
International Society for Clinical Densitometry (ISCD)
In 2013, The International Society for Clinical Densitometry (ISCD) issued a statement on use of DXA body composition. The statement included the following ISCD positions regarding the use of DXA total body composition with regional analysis:
- To assess fat distribution in patients with HIV who are using antiretroviral agents known to increase the risk of lipoatrophy. The statement noted that, although most patients who were taking medications known to be associated with lipoatrophy switched to other medications, some remain on these medications and DXA may be useful in this population to detect changes in peripheral fat before they become clinically evident.
- To assess fat and lean mass changes in obese patients undergoing bariatric surgery when weight loss exceeds approximately 10%. The statement noted that the impact of DXA studies on clinical outcomes in these patients is uncertain.
- To assess fat and lean mass in patients with risk factors associated with sarcopenia, ie, with muscle weakness or poor physical functioning.
U.S. Preventative Services Task Force Recommendations (USPSTF)
The U.S. Preventative Services Task Force (USPSTF) does not recommend DXA for body compositions analysis. In 2012, USPSTF recommended screening all adults for obesity with BMI. Its 2010 recommendation on obesity in children and adolescents recommends screening all children older than 6 years old using BMI.
Whole body dual x-ray absorptiometry (DEXA/DXA) for body composition testing is considered investigational.
Based on the peer reviewed medical literature there is insufficient evidence to support the use of whole body DEXA/DXA for the purpose of determining body composition. It is unclear how information body composition could be used in the active medical management of the patient to alter treatment decisions or improve health outcomes. Well-designed studies evaluating the diagnostic accuracy and clinical utility of this testing are lacking. The technique is considered investigational.
Procedure Codes and Billing Guidelines:
- To report provider services, use appropriate CPT* codes, Alpha Numeric (HCPCS level 2) codes, Revenue codes, and/or diagnosis codes.
- 76499 unlisted diagnostic radiographic procedure
- Methods for Body Composition Analysis in Adults, The Open Obesity Journal, 2011, Volume 3, 62-69
- Centers for Disease Control and Prevention: Healthy Weight: Assessing Your Weight: BMI: About BMI for Adults.
- U.S. Preventative Services Task Force: Screening for and Management of Obesity in Adults.
- U.S. Preventative Services Task Force: Screening for Obesity in Children and Adolescents.
- American Heart Society Body Composition Tests
- International Society for Clinical Densitometry: 2013 ISCD Official Positions-Adult.
- International Society for Clinical Densitometry: 2007 Pediatric Official Positions.
- Agency for Healthcare Research and Quality: Screening and Intervention for Childhood Overweight: Evidence Synthesis. July 2005. Investigators: Evelyn P. Whitlock, M.D., MPH; Selvi B. Williams, M.D.; Rachel Gold, PhD, MPH; Paula Smith, R.N., BSN; Scott Shipman, M.D., MPH
- Evaluation of Lunar Prodigy dual energy x-ray absorptiometry for assessing body composition in healthy persons and patients by comparison with the criterion 4-component model. American Journal of Clinical Nutrition 2006. Jane E. Williams, Jonathan CK Wells, Catherine M. Wilson, Dalia Haroun, Alan Lucas and Mary S. Fewtrell.
- American College of Radiology (ACR) and the Society of Skeletal Radiology (SSR) Practice Guideline for the Performance of Dual Energy X-Ray Absorptiometry (DXA). Revised 2008
- Pediatrics Official Journal of the American Academy of Pediatrics: Prevention of Pediatric Overweight and Obesity Committee on Nutrition, 2003, 112;424
- ACR-SPR-SSR Practice Parameter for the Performance of Dual-Energy X-Ray Asbsorptiometry (DXA), Amended 2014. Also available at www.acr.org
- UpToDate Measurement of Body Composition in Children, Sarah M. Phillips, MS, RD, LD, Robert J. Shulman, M.D., Topic last updated December 19, 2014. Also available at www.uptodate.com
- UpToDate Determining Body Composition in Adults, George A. Bray, M.D., Topic last updated April 17, 2015. Also available at www.uptodate.com
Date Reason Action
September 2013 New policy
August 2014 Annual review Policy renewed
July 2015 Annual review Policy revised
Wellmark medical policies address the complex issue
of technology assessment of new and emerging treatments, devices,
drugs, etc. They are developed to
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coverage nor medical advice. Wellmark medical policies contain only a
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and, therefore, cannot guarantee any results or outcomes.
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and therefore are subject to change without notice.
*Current Procedural Terminology © 2012 American Medical Association. All Rights Reserved.