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PAP 280

Cone Beam Computed Tomography (CBCT)


Provider Administrative Policy

Section
Claims Submission
Policy Date
November 2013
Status/Date
New/November 2013
Provider Type(s)
All Providers  

Disclaimer

Our provider administrative policies contain information regarding claims submission, reimbursement, and other information in order to achieve an efficient relationship with our providers. These policies are not an authorization or explanation of benefits. Blue Cross of Idaho retains the right to add to, delete from and otherwise modify this policy in accordance with our provider contracts


Policy

Cone Beam Computed Tomography (CBCT)

Purpose and Statement of Intent

This policy is intended to promote reasonable and consistent quality and safety requirements for providers of imaging services. We established these requirements to describe the accreditation and certification conditions a person might associate with high-quality imaging services. We hope to establish an environment where qualified operators perform imaging studies using appropriate equipment and techniques and where qualified physicians interpret images.

Description

Cone beam computed tomography (or CBCT) is a medical imaging technique consisting of X-ray computed tomography where the X-rays are divergent, forming a cone. CBCT is appropriate when used in the treatment planning and diagnosis of implant dentistry and orthodontia.

Benefits/Risks

Although the radiation doses from CBCT exams are generally lower than medical-grade CT exams, CBCT exams typically deliver more radiation than conventional X-ray exams. Concerns about radiation exposure are greater for younger patients because they are more sensitive to radiation (i.e., estimates of their lifetime risk for cancer incidence and mortality per unit dose of ionizing radiation are higher) and they have a longer lifetime for ill effects to develop.

There are a number of drawbacks of CBCT technology over that of medical-grade CT scans, such as increased susceptibility to movement artifacts, and the lack of appropriate bone density determination.

The efficacy of CBCT exams has not been demonstrated for studies in non-boney structures on the ears, nose and throat. Medical-grade CT scans can provide an accurate absolute density for the type of tissue depicted. The radiodensity, measured in Hounsfield Units (HU, also known as CT number) is inaccurate in CBCT scans because different areas in the scan appear with different greyscale values depending on their relative positions in the organ being scanned, despite possessing identical densities, because the image value of a voxel of an organ depends on the position in the image volume.

Policy Guidelines

Despite the differences between CBCT technology and medical-grade CTs, CPT currently provides no differential coding. Therefore, as part of the medical decision making process, Blue Cross of Idaho may allow compensation for the CBCT scans; however,  the reimbursement will be at a reduced rate.

Blue Cross of Idaho reserves the right to individually evaluate the medical necessity of CBCT and all associated charges for diagnostics and other procedures requested in conjunction with CBCT scans.


Policy History

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