Medical Policy: 06.01.19 

Original Effective Date: February 2003 

Reviewed: February 2017 

Revised: February 2017 

 

Benefit Application:

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.

 

Description:

In the United States, lung cancer is the leading cause of cancer-related death among genotypical men and genotypical women. The most important risk factor for lung cancer is tobacco use. Other risk factors are small compared with cigarette smoke, these causal factors include exposures to environmental and occupational substances and family history of lung cancer. Most lung cancer patients are diagnosed when their disease is advanced. Due to the prevalence and mortality associated with lung cancer, there has been much interest in developing screening tests for lung cancer, in particular, for at-risk individuals at an earlier and more curable stage.  Individuals with high risk factors who are candidates for screening should not have any symptoms suggestive of lung cancer (e.g. cough, pain, weight loss).  The goal of screening is to detect disease at a stage when it is not causing symptoms and when treatment will be most successful. Screening should benefit the individual by increasing life expectancy and increasing quality of life. 

 

Chest x-ray (CXR) and sputum cytology have been the most common methods used for screening lung cancer, but previous studies have failed to demonstrate that screening with these modalities resulted in improved health outcomes.

 

More recently, low-dose computed tomography (LDCT) has been proposed as a method of screening asymptomatic, high risk individuals for lung cancer.  LDCT refers to a non-contrast study with a multi-detector CT scanner during a single maximal inspiratory breath-hold with a scanning time of under 25 seconds. New multi-detector CT scanners generate high-resolution imaging with radiation exposure significantly less than for diagnostic CT scanning.  It has been suggested that LDCT may be an improved early lung cancer detection tool based on the advantages it appears to have over CXR and sputum cytology to detect lung cancer at an earlier stage. 

 

Shared patient/physician decision making may be the best approach before deciding whether to do LDCT lung cancer screening, especially for patients with comorbid conditions. Wherever possible those individuals who choose to undergo lung cancer screening should enter an organized screening program at an institution with expertise in LDCT screening, with access to a multidisciplinary team skilled in the evaluation, diagnosis and treatment of abnormal lung lesions.


While screening for lung cancer has the potential benefits of decreased morbidity and mortality from lung cancer it also has potential harms, which include:

  • A lung cancer screening test can suggest that a person has lung cancer when no cancer is present, this is called a false-positive result. False positive results can lead to follow up tests or surgeries that are not needed and may have more risks.
  • A lung cancer screening test can find cases of cancer that may never have caused a problem for the patient. This is called over-diagnosis. Over-diagnosis can lead to treatment that is not needed.
  • Radiation from serial imaging in a screening program may add to the risk of developing cancers, including lung cancer. Since screening typically occurs over several rounds and positive studies require further evaluation, the cumulative radiation dose is also important.

 

National Lung Screening Trial

The National Lung Screening Trial (NLST) was a randomized trial sponsored by the National Institute of Health comparing the annual screening by low dose CT scanning with standard chest x-ray for three years in 53, 454 high risk persons at 33 United States medical centers. Participants were men and women 55 to 74 years of age with a history of at least 30 pack years of smoking, current smokers and those who had discontinued smoking within 15 years of enrollment. NLST researchers found approximately 15 to 20 percent fewer lung cancer deaths among trial participants screened with low dose computed tomography (LDCT) compared to the participants screened with chest x-ray.

 

Summary: Randomized controlled trials and cohort studies of screening with chest radiography or low dose computerized tomography (LDCT) demonstrate that chest radiograph screening does not reduce mortality from lung cancer and that LDCT screening is significantly more sensitive than chest radiography for identifying small asymptomatic lung cancers.   The largest RCT, the National Lung Screening Trial (NLST) was a multicenter trial published in 2011. This was a high quality trial that reported a decrease in both lung cancer mortality and overall mortality in a high risk population screened with 3 annual low dose CT scans compared with chest radiographs. There is considerable uncertainty regarding the optimal length and interval screening. Society guidelines recommend annual screening, and that screening should be discontinued once a person has not smoked for 15 years or develops a health problem that substantially limits life expectancy or the ability or willingness to have curative lung surgery. The evidence is sufficient to determine that the technology results in a meaningful improvement in the net health outcomes. Therefore, screening for lung cancer with low dose CT (LDCT) annually may be considered medically necessary for high risk patients who meet criteria and investigational otherwise.

 

Computer Aided Detection (CAD) with Low Dose Computed Tomography for Lung Cancer Screening

Computer aided detection (CAD) systems describe a class of pattern-recognition software designed to analyze radiologic images for patterns suggestive of cancer and highlight them for radiologist review to reduce false-negative readings. Most CAD products for radiology are intended for use with radiographs (x-rays). The most widespread use of CAD technology is associated with mammography to enhance effectiveness of breast cancer screening. However, some manufacturers have developed CAD systems to complement CT exams. To use most CAD products, a radiologist initially reviews the images without CAD, then activates the software to reexamine CAD marked items before issuing a final report. CAD systems are not intended to replace the radiologist review. Adding CAD technology to CT exams has been proposed to enhance the effectiveness of lung cancer screening with chest CT. However, there is few data available to establish whether the addition of CAD to LDCT could improve lung cancer detection rates compared to LDCT alone.

 

Patient Safety Issues

A primary concern with CAD for LCDT would be the risk of increasing the rate of false-positive results that could lead to over-diagnosis of lung lesions unlikely to cause clinical symptoms, resulting in additional unnecessary testing and possible unnecessary treatment.  Another concern would be patients increased cancer risk from increased exposure to ionizing radiation from repeated CT scans. Several investigators have linked the overuse of CT scans to an increased cancer risk over the long term. However, these concerns have prompted manufacturers to introduce new technologies to reduce radiation dose in CT scans.

   

Although the American Medical Association (AMA) has issued Category III Current Procedural Terminology codes to enable billing for CAD with chest x-rays and magnetic resonance imaging (MRI), it has not issued codes for CAD with CT for lung imaging.

 

None of the clinical guidelines cited below address the use of CAD as part of lung cancer screening with LDCT.

        

Summary: The use of computer aided detection (CAD) software may assist in lung cancer screening. However, there is insufficient evidence to determine whether CAD technology may improve the accuracy of CT scanning interpretation. While CAD systems have been shown to detect additional lung nodules compared to the results of human readers alone, the issue is how many detected nodules are lung cancers. The effectiveness of CAD in detecting lung cancer has not been fully investigated. Highly quality randomized trials examining the effect of CAD systems for CT scans on lung cancer morbidity and mortality are necessary to determine the true impact of this technology on health outcomes. Therefore, the use of computer aided detection (CAD) with LCDT for screening for lung cancer is considered investigational. 

 

Practice Guidelines and Position Statements

U.S. Preventative Services Task Force (USPSTF) (B recommendation)

December 2013, the USPSTF recommended annual screening for lung cancer with low dose computed tomography (LDCT) in adults aged 55 to 80 years who have a 30 pack year smoking history and currently smoke or have quit within the past 15 years.

 

Screening should be discontinued once a person has not smoked for 15 years or develops a health problem that substantially limits life expectancy or the ability or willingness to have curative lung surger.

 

A rating of A and B from the USPSTF applies to the Affordable Care Act (ACA) preventative services.  This recommendation is Grade B.

 

National Comprehensive Cancer Network (NCCN)

Lung Cancer Screening (Version 1.2017)

Recommend lung cancer screening using low dose CT scan for high risk individuals:

  • Age 55-74 years and

  • ≥ 30 pack year history of smoking and

  • Smoking cessation <15 years;

  • OR

  • Age ≥ 50 years and

  • ≥ 20 pack year history of smoking and

  • One additional risk factor (other than second hand smoke)

 

Screening Findings: No lung nodule(s) on LDCT - annual screening LDCT until patient is no longer a candidate for definitive treatment.
 
The guideline notes: “there is uncertainty about the appropriate duration of screening and the age at which screening is no longer appropriate.”

 

In candidates for screening, shared patient/physician decision making is recommended, including a discussion of benefits and risks.

 

Individuals with risk factors who are candidates for screening should not have symptoms suggestive of lung cancer (e.g. cough, pain, weight loss).

 

 

American Cancer Society (ACS)

In 2013, the American Cancer Society (ACS) published guidelines on lung cancer screening with low dose CT.  The guidelines recommend doctors initiate a discussion about lung cancer screening with people who meet criteria that put them at risk for developing the disease. These high risk patients must be:

  • Aged 55 to 74 years and in fairly good health

  • Have a smoking history equivalent to a pack a day for 30 years, and

  • Currently smoking or have quit within the past 15 years

For patients who meet the above criteria and choose screening, screening is recommended annually until age 74 for individuals who otherwise remain healthy. In addition, the ACS recommends that adults who choose to undergo lung screening preferably should enter an organized screening program at an institution with expertise in LDCT screening, with access to a multidisciplinary team skilled in the evaluation, diagnosis, and treatment of abnormal lung lesions. 

 

American College of Chest Physicians (ACCP) and the American Society for Clinical Oncology (ASCO)

In May 2012, American College of Chest Physicians (ACCP) and the American Society of Clinical Oncology (ASCO) issued a joint statement on low dose computed tomography (LDCT) screening for lung cancer.  The statement included the following recommendations:

  • For smokers and former smokers ages 55 to 74 who have smoked for 30 pack years or more and either continue to smoke or have quit within the past 15 years, we suggest that annual screening with low dose CT should be offered over both annual screening with chest radiograph or no screeing, but only in settings that can deliver the comprehensive care provided to National Lung Screening Trial Participants. (Grade of eidence 2B)
  • For individuals who have accumulated fewer than 30 pack years of smoking, or are either younger than 55 or older than 74, or individuals who quit smoking more than 15 years ago, and for individuals with severe co-morbidities that would preclude potentially curative treatment and/or limit life expectancy, we suggest that CT screening should not be performed. (Grade of evidence 2C)  

 

American College of Chest Physicians (ACCP)

In 2013 The American College of Chest Physicians (ACCP) issued evidence based clinical practice guidelines on screening for lung cancer. The guideline included the following recommendation:

 

For smokers and former smokers who are age 55 to 74 and who have smoked for 30 pack years or more and either continue to smoke or have quit within the past 15 years, we suggest that annual screening with low dose CT (LDCT) should be offered over both annual screening with CXR or no screening, but only in settings that can deliver the comprehensive care provided to National Lung Screening Trial Participants. (Grade 2B)

 

For individuals who have accumulated fewer than 30 pack years of smoking or are either younger than age 55 or older than 74, or individuals who quit smoking more than 15 years ago, and for individuals with severe comorbidities that would preclude potentially curative treatment and/or limit life expectancy, we suggest that CT screening should not be performed. (Grade C).

 

American Association for Thoracic Surgery

In 2012, American Association for the Thoracic Surgery published guidelines for lung cancer screening.  The guidelines recommend annual lung cancer screening with low dose computed tomography (LDCT) for the following individuals:

  • Age 55 to79 years
  • With ≥ 30 pack year smoking history

Also, low dose computed tomography lung cancer screening should be offered at 50 to 79 years with a 20 pack year smoking history and additional comorgidity that produces cummulative risk of developing lung cancer of  ≥ 5% in 5 years.

 

American Lung Association

In 2012, the American Lung Association Lung Cancer Screening Subcommittee released an interim report with the following recommendations:

  • Low dose CT screening should be recommended for those individuals who meet NLST criteria
    • Current or former smokers aged 55 to 74
    • A smoking history of at least 30 pack years
    • No history of lung cancer

 

Prior Approval:

 

Not applicable.

 

Policy:

This policy does not apply to individuals with signs and/or symptoms of lung disease. In symptomatic individuals, a diagnostic work up appropriate to the clinical presentation should be undertaken, rather than screening.

 

Low-dose computed tomography (LDCT) scanning, no more frequently than annually, may be considered medically necessary as a screening technique for lung cancer in individuals who meet ALL of the following criteria:*

  • Individuals 55 through 80 years of age; and
  • Have a 30 pack-year smoking history; and
  • Currently smoke or have quit within the past 15 years

*Patient selection criteria is based on U.S. Preventative Services Task Force (USPSTF) and the National Lung Screening Trail (NLST).

 

Low-dose computed tomography (LDCT) is considered investigational as a screening technique for lung cancer when the above criteria is not met and for all other screening indications.

 

The evidence on low dose computed tomography (LDCT) screening for lung cancer includes several randomized clinical trials and cohort studies. The largest randomized clinical trial, the National Lung Screening Trial (NLST) was a multicenter trial published in 2011. This was a high quality trail that reported a decrease in both lung cancer mortality and overall mortality in high risk population screened with 3 annual low dose computed tomography (LDCT). There is still uncertainty regarding the optimal length and interval of screening.  Society guidelines recommend annual screening, and that screening should be discontinued once a person has not smoked for 15 years or develops a health problem that substantially limits life expectancy or the ability or willingness to have curative lung surgery. The evidence is sufficient to determine that the technology results in a meaningful improvement in the net health outcomes.  Therefore, screening for lung cancer with low dose computed tomorgraphy (LDCT) may be considered medically necessary for high risk patients who meet the eligibility criteria above and investigational for all other screening indications.

 

Lung cancer screening using low dose computed tomography (LDCT) would be considered not medically necessary for the following indications:

  • Once the patient has not smoked for 15 years; or
  • A patient develops a health problem that substantially limits life expectancy; or
  • The patient is unwilling to have curative lung surgery.

Computer Aided Detection with LDCT

The use of computer aided detection (CAD) with low dose computed tomography for lung cancer screening is considered investigational.

 

There is insufficient evidence to determine whether CAD technology may improve the accuracy of CT scanning interpretation. While CAD systems have been shown to detect additional lung nodules compared to the results of human readers alone, the issue is how many detected nodules are lung cancers. The effectiveness of CAD in detecting lung cancer has not been fully investigated. Highly quality randomized trials examining the effect of CAD systems for CT scans on lung cancer morbidity and mortality are necessary to determine the true impact of this technology on health outcomes. Therefore, the use of computer aided detection (CAD) with LCDT for screening for lung cancer 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.
  • G0297 Low dose CT scan (LDCT) for lung cancer screening

 

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.
  • American Society of Clinical Oncology (ASCO) 45th Annual Meeting: Abstract CRA 1502.   Presented May 30, 2009.
  • Bach PB, Silvestri GA, Hanger M et al. Screening for Lung Cancer. ACCP Evidence-based clinical practice guidelines (2nd edition). Chest. 2007 Sep; 132 (3 Suppl) 69S-77S.
  • Hocking WG, Oken MM, Winslow SD et al. Lung cancer screening in the randomized prostate, lung, colorectal and ovarian (PLCO) cancer screening trial. J Natl Cancer Inst 2010; 102(10):722-31.
  • van Klaveren RJ Oudkerk M, Prokop M et al. Management of lung nodules detected by volume CT screening. N Engl J Med 2009; 361(23):2221-9.
  • Croswell JM, Baker SG, Marcus PM et al. Cumulative incidence of false-positive test results in lung cancer screening. Ann Intern Med 2010; 152(8):505-12.
  • National Lung Cancer Screening Trial Research Team; Aberle DR, Adams AM, Berg CD et al. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med 2011; 365(5):395-409.
  • van den Bergh KA, Essink-Bot ML, Borsboom GJ et al. Long-term effects of lung cancer computed tomography screening on health-related quality of life: the NELSON study. Eur Respir J 2011; 38(1):154-61.
  • American Cancer Society Lung Cancer (non-small cell). Last revised July, 2011. Last accessed September 2011.
  • ECRI Institute Professional societies endorse low-dose CT scans for lung cancer screening in high-risk patients. Plymouth Meeting (PA): ECRI Health Technology Assessment InformationService; 2012 August 1. [Health Technology Trends].
  • Bach PB, Mirkin JN, Oliver TK, et al. Benefits and harms of CT screening for lung cancer: a systematic review. JAMA. 2012 Jun 13;307(22):2418-29.
  • Saghir Z, Dirksen A, Ashraf H, et al. CT screening for lung cancer brings forward early disease. The randomized Danish Lung Cancer Screening Trial: status after five annual screening rounds with low-dose CT. Thorax. 2012 Apr;67(4):296-301.
  • U.S. Preventative Services Tesk Force (USPSTF) Screening for Lung Cancer Recommendation Statement.
  • National Comprehensive Cancer Network (NCCN), Lung Cancer Screening Version 1.2014.
  • American Cancer Society New Lung Cancer Screening Guidelines for Heavy Smokers, January 11, 2013.
  • National Cancer Institute National Lung Screening Trial (NLST), NCI Press Release, NIH Funded Study Shows 20 Percent Reduction in Lung Cancer Mortality with Low Dose CT Compared to Chest X-Ray.
  • American Association for Thoracic Surgery Guidelines for Lung Cancer Screening Using Low Dose Computed Tomography Scans for Lung Cancer Survivors and Other High Risk Groups, Michael T. Jaklitsch, M.D. et al. The Journal of Thoracic and Cardiovascular Surgery, Volume 144, Number 1. July 2012. PMID 22710039
  • The American Society of Clinical Oncology (ASCO), The Role of CT Screening for Lung Cancer in Clinical Practice. The Evidence Based Practice Guideline of the American College of Chest Physicians and the American Society for Clinical Oncology. Peter B. Back, M.D., et al. May 2012.
  • UpToDate Screening for Lung Cancer. Mark E. Deffebach, M.D., Linda Humphrey, M.D. Topic last updated March 11, 2014.
  • Peter B. Bach M.D., MAPP; Joshua N. Mirkin BA. Et. al. Benefits and Harms of CT Screening for Lung Cancer; A Systemic Review. JAMA May 20, 2012, Vol 307, No 22
  • National Comprehensive Cancer Network (NCCN) Lung Cancer Screening Version 1.2015.
  • American Lung Association Providing Guidance on Lung Cancer Screening to Patients and Physicians, April 23, 2012.
  • UpToDate Screening for Lung Cancer, Mark E. Deffebach, M.D., Linda Humphrey, M.D.. Topic last updated January 15, 2015.
  • ECRI Health Technology Forecast Computed Tomography with Computer-Aided Detection for Lung Cancer Screening. Published December 2013, Updated February 2015. 
  • National Comprehensive Cancer Network (NCCN) Lung Cancer Screening  Version 1.2016. Also available at
  • American Academy of Family Physicianst Lung cancer clinical recommendations.
  • Centers for Medicare and Medicaid Services National Coverage Determination (NCD) 2010.14 Lung Cancer Screening with Low Dose Computed Tomography (LDCT).
  • National Cancer Institute Lung Cancer Screening PDQ.
  • Detterback F, Mazzone P, Naidich D, Back P. Screening for Lung Cancer – Diagnosis and Management of Lung Cancer, 3rd ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2013;14395)(Suppl):e78S-e92S 
  • Bach PB, Mirkin JN, Oliver TK, et. al. Benefits and harms of CT screening for lung cancer: a systematic review. JAMA 2012 Jun 13;307(22):2418-29 
  • California Technology Assessment Forum (CTAF). Low Dose Spiral Computerized Tomography (LDSCT) Screening for Lung Cancer. Technology Assessment October 19, 2011.
  • Saghir Z, Dirksen A, Ashraf H, et. al. CT screening for lung cancer brings forward early disease. The randomized Danish Lung Cancer Screening Trial: status after five annual screening rounds with low dose CT. Thorax 2012 Apr;67(4):296-301
  • American Thoracic Society/American College of Chest Physicians. An official American Thoracic Society/American College of Chest Physicians policy statement: Implementation of low dose computed tomography lung cancer screening programs in clinical practice.Am J Respir Crit Care Med 2015 Oct 1:192(7):881-91. PMID 26426785
  • American College of Chest Physicians. Diagnosis and Management of Lung Cancer 3rd ed. American College of Chest Physicians Evidence Based Clinical Practice Guidelines, Screening for Lung Cancer. Chest 2013;143(5)(Suppl):e78S-e92S
  • American College of Radiology (ACR)/Society of Thoracic Radiology (STR) Practice parameters for the performance and reporting of lung cancer screening thoracic computed tomography (CT) 2014.
  • Centers for Disease Control (CDC) Lung Cancer.
  • UpToDate. Preventative Care in Adults: Recommendations. H Nancy Sokol M.D., Topic last updated May 4, 2016.
  • Humphrey LL, Deffebach M, Pappas M. et. al. Screening for lung cancer with low dose computed tomography: a systematic review to update the US Preventative Services Task Force recommendation. Ann Intern Med 2013 Sep 17;159(6):411-20. PMID 23897166
  • Manser R. Lethaby A, Irving LB, et. al. Screening for lung cancer. Cochrane Database Syst Rev 2013 Jun 21;(6):CD001991. PMID 23794187
  • Gould M. Lung cancer screening with low dose computed tomography. N Engl J Med 2014;371:1813-20

 

Policy History:

  • February 2017 - Annual Review, Policy Revised
  • February 2016 - Annual Review, Policy Renewed
  • March 2015 - Annual Review, Policy Revised
  • April 2014 - Reinstated, Policy Revised
  • April 2013 - Interim Review, Policy Retired
  • September 2012 - Annual Review, Policy Renewed
  • September 2011 - Annual Review, Policy Revised
  • October 2010 - Annual Review, Policy Renewed

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.

 

*CPT® is a registered trademark of the American Medical Association.