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Medical Policy: 06.01.19
Original Effective Date: February 2003
Reviewed: April 2008
Revised: March 2007
This policy applies to all products unless specific contract
limitations, exclusions or exceptions apply. Please refer to the member's coverage
manual for benefit availability. Managed care guidelines related to referral authorization,
and precertification of inpatient hospitalization, home health, home infusion and
hospice services apply.
Description:
CT screening for lung cancer is intended for use in asymptomatic individuals believed to be at high-risk for the disease, as opposed to the use of CT to diagnose those with symptoms or clinical signs. Numerous studies have failed to demonstrate improvements in mortality rates directly related to CT screening and, in fact, have suggested there is potential for greater harm than benefit due to false positive results and potentially unnecessary treatments.
Computer-aided detection is an adjunct intended to provide computerized image recognition. Designed to assist and improve radiologists’ interpretation of chest radiographs and CT, computer-aided technology uses algorithms to highlight regions of interest and prompt a second look at the original image.
Policy:
CT screening for lung cancer, with or without computer-aided detection, in the asymptomatic patient is considered investigational because there is insufficient evidence that it leads to improved health outcomes.
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Procedure Codes and Billing
Guidelines:
- To report provider services, use appropriate CPT* codes, Alpha Numeric (HCPCS level 2) codes, Revenue codes, and/or ICD-9 diagnostic codes.
- CPT code 71250 with the ICD-9 code V76.0 (special screening for malignant neoplasm of respiratory organs).
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Selected References:
- Mahadevia PJ, Fleisher LA, Frick KD, Eng J, Goodman SN, Powe NR. Lung cancer screening with helical computed tomography in older adult smokers. A decision and cost effective analysis. JAMA 2002;289(3)313-322.
- Gohagan J, Marcus P, Fagerstrom R, Pinsky P, Kramer B, Prorok P; Writing Committee, Lung Screening Study Research Group. Baseline findings of a randomized feasibility trial of lung cancer screening with spiral CT scan vs chest radiograph: the Lung Screening Study of the National Cancer Institute. Chest. 2004 Jul;126(1):114-21.
- Institute for Clinical Systems Improvement (ICSI). Computed tomography screening for lung cancer. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); February 2001. ICSI Technology Assessment Report #52.
- ECRI. Computed tomography for lung cancer screening. Plymouth Meeting (PA): ECRI Health Technology Assessment Information Service; 2005 Jan. (Health Technology Forecast Report).
- ECRI. Helical computed tomography (CT) for lung cancer screening. Plymouth Meeting (PA): ECRI Health Technology Assessment Information Service; 2004 July. TARGET [database online].
- Swensen SJ, Jett JR, Hartmen TE et al. CT screening for lung cancer: five-year prospective experience. Radiology. 2005 Apr;235(1):259-65.
- Henschke CI, Yankelevitz DF, Miettinen OS. Computed Tomographic Screening for Lung Cancer: The Relationship of Disease Stage to Tumor Size. Arch Intern Med 2006; 166:321-25.
- Lindell RM, Hartman TE, Swensen SJ et al. Five-year Lung Cancer Screening Experience: CT Appearance, Growth Rate, Location, and Histologic Features of 61 Lung Cancers. Radiology. 2007 Feb;242(2):555-62.
- The Early Lung Cancer Action Program Investigators. Survival of Patients with Stage I Lung Cancer Detected on CT Screening. N Engl J Med. 2006;355:1763-1771.
- Bach PB, Jett JR, Pastorino U et al. Computed Tomography Screening and Lung Cancer Outcomes. JAMA. 2007;297:953-961.
- Black C, de Verteuil R, Walker S, Ayres J, Boland A, Bagust A, Waugh N. Population screening for lung cancer using computed tomography, is there evidence of clinical effectiveness? A systematic review of the literature. Thorax, 2007 Feb;62(2):131-8.
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New information or technology that would be relevant for Wellmark to consider when this policy is next reviewed may be submitted to:
Wellmark Blue Cross and Blue Shield
Medical Policy Analyst
Station 304
636 Grand Ave.
Des Moines, IA 50309
*Current Procedural Terminology © 2008 American Medical Association. All Rights Reserved.
Wellmark medical policies address the complex issue
of technology assessment of new and emerging treatments, devices,
drugs, etc. They are developed to
assist in administering plan benefits and constitute neither offers of
coverage nor medical advice. Wellmark medical policies contain only a
partial, general description of plan or program benefits and do not
constitute a contract. Wellmark does not provide health care services
and, therefore, cannot guarantee any results or outcomes.
Participating providers are independent contractors in private
practice and are neither employees nor agents of Wellmark or its
affiliates. Treating providers are solely responsible for medical
advice and treatment of members. Our medical policies may be updated
and therefore are subject to change without notice.
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