BlueCross BlueShield of Tennessee Medical Policy Manual

Radiology

• Computer Assisted Surgical Navigation for Orthopedic Procedures

• Coronary Computed Tomography Angiography (CCTA)

• Digital Breast Tomosynthesis

• Digital Health Technologies: Diagnostic Applications

• Dynamic Spinal Visualization and Vertebral Motion Analysis

• Electronic Brachytherapy for Non-Melanoma Skin Cancer

• First-Trimester Detection of Down Syndrome Using Fetal Ultrasound Markers Combined with Maternal Serum Assessment

• Image-Guided Minimally Invasive Decompression for Spinal Stenosis

• Intensity-Modulated Radiotherapy (IMRT) of the Breast and Lung

• Intraocular Radiation Therapy for Age-Related Macular Degeneration

• Intraoperative Radiation Therapy (IORT)

• Mammography

• MRI-Guided Focal Laser Ablation for Prostate Cancer

• MRI-Guided Focused Ultrasound (MRgFUS)

• MRI-guided Laser-induced Thermotherapy for Neurological Indications

• Myocardial Sympathetic Innervation Imaging for Individuals with Heart Failure

• Noninvasive Imaging Techniques for Evaluation and Monitoring of Chronic Liver Diseases

• Nonoperative Diagnostic Spinal Ultrasound (Echography/Sonogram)

• Percutaneous Sacroplasty

• Percutaneous Vertebroplasty and Kyphoplasty

• Positron Emission Tomography (PET) for Cardiac Applications

• Proton Beam Therapy

• Radiotherapy for Prostate Cancer

• Thermography

• Ultrasonographic Measurements of Carotid Intima-Medial Thickness (CIMT) as an Assessment of Subclinical Atherosclerosis

• Vertebral Fracture Assessment with Densitometry

• Whole Body Dual X-Ray Absorptiometry (DEXA) to Determine Body Composition

This document has been classified as public information.