Appeal type: Medical necessity
Decision: Overturned

Diagnosis: Breast cancer
Treatment: Bioimpedance spectroscopy testing, code 93702
The insurer denied coverage for bioimpedance spectroscopy testing, code 93702.
The denial is overturned.

The medical records indicate the patient has a history of breast cancer and underwent a bilateral mastectomy.

A letter of medical necessity noted "the patient has a family history of breast cancer. The patient's right bilateral screening mammogram noted scattered fibroglandular densities and a subsequent right mammogram confirmed calcifications in the lower right breast. The patient had a right breast stereotactic biopsy and pathology indicated papillary carcinoma in situ and focal papillary in situ ER (estrogen receptor) and PR (progesterone receptor) positive. She underwent a bilateral mastectomy and right sentinel lymph node biopsy. Five lymph nodes were removed, and none were positive for disease."

The patient underwent bioimpedance spectroscopy testing that was denied and is being appealed at this time. The requested, bioimpedance spectroscopy testing, code 93702 was considered medically necessary for this patient. 

The literature does demonstrate that the use of this device to screen for lymphedema is effective and can lead to early intervention and prevention of lymphedema. This is an appropriate strategy to perform in individuals at risk for lymphedema as in this case.

This is a Food and Drug Administration (FDA) approved device that has been shown to predict risk of lymphedema. It is not under study and has regulatory approval for use. 

"Bioimpedance spectroscopy is currently used to evaluate patients with breast cancer-related lymphedema (BCRL). We aimed to describe published studies on the use of bioimpedance spectroscopy for assessment for BCRL. We queried the PubMed, Ovid Medline, and Embase databases to identify studies that evaluated the use of bioimpedance spectroscopy as an assessment tool. We searched for the keywords "bioimpedance" AND ("lymphedema" OR "lymphoedema"). We included English-language studies that reported the use of bioimpedance spectroscopy for assessment of BCRL. Out of 152, 116, and 235 articles identified in each database, respectively, only a total of 11 articles were included. Bioimpedance spectroscopy was studied as a method to assess and predict response to BCRL treatment, assess volume changes, and calibrate L-Dex (Lymphedema Index) scores for conversion to units of volume. All studies reported that bioimpedance spectroscopy is a promising tool for predicting response to BCRL treatment and measuring volume changes. Bioimpedance spectroscopy can be used for assessment of BCRL." (Forte, A. J. et al., 2020).

The literature does demonstrate that the use of this device to screen for lymphedema is effective and can lead to early intervention and prevention of lymphedema. This is an appropriate strategy to perform in individuals at risk for lymphedema as in this case.                                                            

The health plan did not act reasonably with sound medical judgment in the best interest of the patient.

The insurer's denial of coverage for bioimpedance spectroscopy testing, code 93702 is overturned. Medical Necessity is substantiated.