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Medical Polices

6.0 Radiology


6.01 Radiology Introduction 
For Blue Cross of Idaho`s definition of medically necessary and investigational, please click here. 
6.01.01 Bone Mineral Density Studies 
6.01.03 Computed Tomography to Detect Coronary Artery Calcification 
6.01.06 Miscellaneous (non-cardiac, non-oncologic) Applications of Positron Emission Tomography (PET) 
6.01.07 Transcranial Doppler Ultrasound 
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 
6.01.18 Scintimammography/Breast-Specific Gamma Imaging/Molecular Breast Imaging
6.01.20 Cardiac Applications of PET Scanning 
6.01.21 Magnetoencephalography/Magnetic Source Imaging
6.01.23 Diagnosis and Treatment of Sacroiliac Joint Pain
6.01.25 Percutaneous Vertebroplasty and Sacroplasty
6.01.26 Oncologic Applications of PET Scanning
6.01.29 MRI of the Breast
6.01.30 Screening for Lung Cancer Using CT Scanning
6.01.32 Virtual Colonoscopy/CT Colonography 
6.01.33 Wireless Capsule Endoscopy as a Diagnostic Technique in Disorders of the Small Bowel and Esophagus, and Colon
6.01.37 Radioimmunoscintigraphy Imaging (Monoclonal Antibody Imaging) with Indium-111 Capromab Pendetide (Prostascint®) for Prostate Cancer
6.01.38  Percutaneous Balloon Kyphoplasty and Mechanical Vertebral Augmentation 
6.01.39 Computer-aided Detection in Conjunction with Digitized Screen-Film Mammography or Full-Field Digital Mammography
6.01.40  Whole Body Dual X-Ray Absortiometry (DEXA) to Determine Body Composition 
6.01.41 Whole Body Computed Tomography Scan as a Screening Test
6.01.43 Contrast-Enhanced Computed Tomography Angiography (CTA) for Coronary Artery Evaluation
6.01.44 Vertebral Fracture Assessment with Densitometry 
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 Magnetic Resonance Imaging
6.01.48 Positional Magnetic Resonance Imaging
6.01.49 CT (Computed Tomography) Perfusion Imaging
6.01.50 Use of Magnetic Resonance Imaging to Monitor Integrity of Silicone Gel-Filled Breast Implants 
6.01.51  PET Scanning in Oncology to Detect Early Response during Treatment 
6.01.52  Positron Emission Mammography (PEM) 
6.01.53 Digital Breast Tomosynthesis
6.01.54 Dopamine Transporter Imaging with Single Proton Emission Computed Tomography (DAT-SPECT)
6.01.55 Beta-amyloid Imaging with Positron Emission Tomography (PET) Alzheimer's Disease
6.01.56 Myocardial Sympathetic Innervation Imaging in Patients with Heart Failure
6.01.57 Radioactive Seed Localization of Nonpalpable Breast Lesions

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