Coverage Policy Manual
Policy #: 2004054
Category: Radiology
Initiated: October 2004
Last Review: May 2018
  Whole Body Computed Tomography Scan as a Screening Test

Description: Whole body CT scans, encompassing 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), and abdominal and pelvic organs (cancer, cardiovascular disease). Often the test is marketed directly to the patient and is offered through mobile CT scanners that travel from community to community.

CT scanning to detect coronary calcium is addressed in policy 1997061 - Electron Beam Computed Tomography.

There is no specific CPT code for whole body CT scanning.

Policy/
Coverage:
Effective, September 2009
Whole body computed tomography is a contract exclusion for most fully insured group contracts.
 
For contracts without this specific exclusion, Whole body computed tomography does not meet Primary Coverage Criteria that there be scientific evidence of effectiveness in improving health outcomes and is considered investigational.  For members with contracts without primary coverage criteria, investigational services are specific contract exclusions.
 
Effective, March 2009
Whole body computed tomography is not covered because it does not meet the Primary Coverage Criteria of effectiveness in improving health outcomes. In addition, screening tests are listed as specific contract exclusions in most Member Benefit Certificates.
 
For contracts without Primary Coverage Criteria, whole body computed tomography is considered investigational.
 
Effective, October 2004
Whole body computed tomography as a screening test is considered investigational.  Investigational services are an exclusion in the member's benefit contract.
 
 
 
 
 

Rationale:
In September 2002, the American College of Radiology published the following statement regarding whole body CT scanning:
“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.
 
In addition, the Food and Drug Administration has published the following information on whole body CT scanning:
“Currently some medical imaging facilities are promoting a new use of computed tomography (CT), also called computerized axial tomography (CAT) scanning. This use is referred to as whole-body CT scanning or whole-body CT screening, and it is marketed as a preventive or proactive healthcare measure to healthy individuals who have no symptoms or suspicion of disease. At this time the FDA knows of no data demonstrating that whole-body CT screening is effective in detecting any particular disease early enough for the disease to be managed, treated, or cured and advantageously spare a person at least some of the detriment associated with serious illness or premature death. Any such presumed benefit of whole-body CT screening is currently uncertain, and such benefit may not be great enough to offset the potential harms such screening could cause. Public health agencies and national medical and professional societies-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 -do not recommend CT screening.
 
A recent review article also concluded that “no published studies demonstrate that these procedures reduce morbidity or mortality when used to screen healthy, asymptomatic patients” (Dixon, 2003).
 
2009 Update
Two retrospective reviews of findings/recommendations from 982 and 1,192 whole body CT screenings were published (Obuchowski, 2006) (Furtado, 2005).  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; follow-up imaging was the most common recommendation.   Obuchowski et al conducted 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 (Obuchowski, 2007).  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 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. Current literature does not support an improvement in health outcomes with whole body CT screening.
 
2012 Update
A search of the MEDLINE database did not reveal any new information that would prompt a change in the coverage statement.
  
2014 Update
A literature search conducted through April 2014 did not reveal any new information that would prompt a change in the coverage statement.
 
2015 Update
A literature search was conducted using the MEDLINE database through April 2015. There was no new literature identified that would prompt a change in the coverage statement.
 
2017 Update
A literature search conducted through April 2017 did not reveal any new information that would prompt a change in the coverage statement.
 
 
2018 Update
Annual policy review completed with a literature search using the MEDLINE database through April 2018. No new literature was identified that would prompt a change in the coverage statement.   

References: Brenner DJ, Elliston CD.(2004) Estimated radiation risks potentially associated with full-body CT screening. Radiology 2004; 232:735-8.

Dixon GD.(2003) Computed tomography for screening purposes: a review of the literature. Mo Med 2003; 100:140-4.

Furtado CD, Aguirre DA, Sirlin CB et al.(2005) Whole-body CT screening: spectrum of findings and recommendations in 1192 patients. Radiology 2005; 237(2):385-94.

Hampton T.(2004) Full-body CT scans scale up cancer risk. JAMA 2004; 292:1669.

Obuchowski N, Modic MT.(2006) Total body screening: predicting actionable findings. Acad Radio 2006; 13(4):480-5.

Obuchowski NA, Holden D, Modic MT et al.(2007) Total-body screening: preliminary results of a pilot randomized controlled trial. J Am Coll Radiol 2007; 4(9):604-11.

US Food and Drug Administration.(2003) Full-body CT scans. What you need to know. www.fda.org, 2003; accessed 10/04.


Group specific policy will supersede this policy when applicable. This policy does not apply to the Wal-Mart Associates Group Health Plan participants or to the Tyson Group Health Plan participants.
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