Medical thermography, also known as Digital Infrared Thermal Imaging (DITI), is a non-invasive imaging technique. It uses an infrared camera to map heat patterns radiating from the body’s surface, based on the idea that temperature changes correlate with underlying physiological processes like inflammation or increased blood flow. Insurance coverage for thermography is highly conditional and often denied, meaning patients typically pay for the procedure out-of-pocket.
Why Coverage is Usually Denied
Most health insurance companies deny coverage because thermography is designated as an “investigational” or “experimental” procedure. Payers conclude there is insufficient scientific evidence to establish the technology’s effectiveness as a stand-alone diagnostic tool for most medical conditions. This lack of robust, peer-reviewed data demonstrating improved health outcomes is the major barrier to coverage.
For breast screening, one of the most common uses, the U.S. Food and Drug Administration (FDA) has cleared thermography devices only as an adjunctive imaging tool. This means it must be used alongside a structural test like mammography. The FDA explicitly warns against using thermography as a replacement for mammography for cancer screening or diagnosis, reinforcing the position that it is not medically necessary for routine screening.
The investigational designation also affects the billing process because there is no specific, widely accepted Current Procedural Terminology (CPT) code for general thermographic screening. The code often used is 93740 (“Temperature gradient studies”), which many payers have specifically flagged as non-covered for thermography applications. The lack of a clear, universally recognized code further complicates claim submission and often results in an automatic denial.
Payer Policies and Coverage Exceptions
Federal programs like Medicare and Medicaid generally do not cover thermography for screening purposes. Medicare’s long-standing policy states that available evidence does not support thermography as a useful aid in the diagnosis or treatment of illness or injury, excluding it from coverage. This precedent is followed by many other payers.
Private insurance plans, including Preferred Provider Organizations (PPOs) and Health Maintenance Organizations (HMOs), rarely cover thermography, though policies can vary slightly. Most major private insurers classify thermography as experimental for nearly all indications, including screening for breast cancer, vascular disease, or general wellness. In the rare instance a policy provides coverage, it is usually only for narrowly defined diagnostic uses.
Limited exceptions often involve the diagnosis of specific nerve or pain disorders where objective temperature changes are a known clinical feature. For example, some plans might cover it for the evaluation of Complex Regional Pain Syndrome (CRPS), where the condition often causes measurable temperature asymmetry between limbs. However, even in these cases, coverage is not guaranteed, and pre-authorization is almost always required to demonstrate that all other standard diagnostic methods have been exhausted.
Costs, Appeals, and Financial Alternatives
Since coverage is uncommon, patients should expect to pay for thermography services entirely out-of-pocket at the time of the scan. Costs vary significantly based on the type of scan and geographic location. A breast scan or single area of interest ranges from approximately $175 to $275, while a full-body scan costs $375 to $495. These self-pay prices do not include the cost of interpretation by a physician.
If a claim is denied, the patient has the right to file an internal appeal with the insurance company, followed by an external review by an independent third party if the internal appeal fails. The appeal process requires submitting a formal appeal letter, the Explanation of Benefits (EOB) showing the denial, and a detailed letter of medical necessity from a physician. This necessity letter must clearly state the patient’s specific diagnosis and provide clinical rationale for why thermography is necessary, citing supporting medical literature.
Appeals for thermography are often unsuccessful because the service is denied based on its investigational status, a policy decision difficult to overturn case-by-case. However, patients can use funds from a Health Savings Account (HSA) or a Flexible Spending Account (FSA) to pay for the cost of the scan. These tax-advantaged accounts can be utilized for thermography expenses, especially if they are accompanied by a physician’s letter of medical necessity, providing a viable financial alternative when insurance coverage is unavailable.