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Behavioral Health Management

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Medical Polices

6.0 Radiology


6.01 Radiology Introduction 
Medically
Necessary
and
Investigational
 For Blue Cross of Idaho`s definition of medically necessary and investigational, please click here. 
6.01.01 Bone Mineral Density Studies 
6.01.02 Digital Subtraction Angiography 
6.01.03 Computed Tomography to Detect Coronary Artery Calcification 
6.01.04 Intravascular Ultrasound Imaging of Coronary Arteries 
6.01.06 Miscellaneous Applications of Positron Emission Tomography (PET) 
6.01.07 Transcranial Doppler Ultrasound 
6.01.08 Transrectal Ultrasound of the Prostate 
6.01.09 Vacuum-Assisted Breast Biopsy 
6.01.10 Stereotactic Radiosurgery and Stereotactic Body Radiation Therapy 
6.01.11 Herniography
6.01.12 Thermography
6.01.15 Videofluoroscopic Evaluation of Velopharyngeal Dysfunction 
6.01.16 Magnetic Resonance Angiography of Vessels of the Head, Neck, Abdomen, Pelvis, and Lower Extremity 
6.01.17 Magnetic Resonance Angiography (MRA) of the Chest (excluding the heart) 
6.01.18 Scintimammography
6.01.19 Intracoronary Doppler Ultrasound 
6.01.20 Cardiac Applications of PET Scanning 
6.01.21 Magnetoencephalography/Magnetic Source Imaging
6.01.22 Scintigraphy of Acute Deep Venous Thrombus
6.01.23 Sacroiliac Joint Arthrography
6.01.24 Magnetic Resonance Spectroscopy
6.01.25 Percutaneous Vertebroplasty and Kyphoplasty 
6.01.26 Oncologic Applications of PET Scanning
6.01.27 FDG Using Camera-Based Imaging (FDG-SPECT)
6.01.28 Transrectal Ultrasound for Staging Rectal Cancer
6.01.29 MRI of the Breast
6.01.30 Screening for Lung Cancer Using CT Scanning or Chest Radiographs
6.01.32 Virtual Colonoscopy/CT Colonography as a Screening Test for Colorectal Cancer
6.01.33 Wireless Capsule Endoscopy as a Diagnostic Technique in Disorders of the Small Bowel and Esophagus
6.01.34 Full-Field Digital Mammography
6.01.35 Scintigraphy Using Indium-111 Pentetreotide (Octreoscan)
6.01.36 Radioimmunoscintigraphy Imaging (Monoclonal Antibody Imaging) Using In-111 Satumomab Pendetide (OncoScint) or Tc-99m Arcitumomab (IMMU-4, CEA-Scan)
6.01.37 Radioimmunoscintigraphy Imaging (Monoclonal Antibody Imaging) with Indium-111 Capromab Pendetide (Prostascint®) for Prostate Cancer
6.01.39 Computer-aided Detection in Conjunction with Digitized Screen-Film Mammography or Full-Field Digital Mammography
6.01.41 Whole Body Computed Tomography Scan as a Screening Test
6.01.42 Magnetic Resonance Cholangiopancreatography
6.01.43 Contrast-Enhanced Computed Tomographic Angiography (CTA) for Coronary Artery Evaluation
6.01.44 Screening for Vertebral Fracture with Dual X-ray Absorptiometry (DEXA)
6.01.45 Computer-Aided Detection of Malignancy with Magnetic Resonance Imaging of the Breast
6.01.46 Dynamic Spinal Visualization
6.01.47 Functional MRI
6.01.48 Positional Magnetic Resonance Imaging ( MRI)
6.01.49 CT (Computed Tomography) Perfusion Imaging
6.01.50 Magnetic Resonance Imaging to Monitor Integrity of Silicone Gel-Filled Breast Implants 

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