S52.539S — Colles' fracture of unspecified radius, sequela
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- Where thermography findings are discussed in studies, results are generally recommended to be correlated with alternative imaging techniques (e.g., mammography, ultrasound, MRI) — i.e., thermography should not be used as a standalone diagnostic test and correlation with standard diagnostic imaging/clinical findings is needed.
- No specific documentation requirements are stated in the Clinical Policy Bulletin. (The policy does not list required medical records, test results, or clinical documentation for thermography because thermography is considered experimental/investigational and not covered for the listed indications.)
Key Coverage Criteria
- No covered indications are stated in this document. (The policy background notes that, based on an OHTA study, the Health Care Financing Administration/CMS withdrew Medicare coverage of thermography.)
- Dynamic infrared blood perfusion imaging (DIRI) for intra-operative and post-operative perfusion assessment is considered experimental and investigational (effectiveness not established).
- None. Aetna considers thermography (including digital infrared thermal imaging, magnetic resonance (MR) thermography and temperature gradient studies) experimental and investigational for all indications because available medical literature indicates that the effectiveness of thermography as a diagnostic technique has not been established.
1 Active Policy
AETNA-CPB-0029 — Thermography
Related Codes
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