Anthem Blue Cross Connecticut Commercial Clinical Policy

Anthem Blue Cross Connecticut RAD.00065 Radiostereometric Analysis (RSA) Form

Effective Date

01/03/2024

Last Reviewed

11/09/2023

Original Document

  Reference



This document addresses radiostereometric analysis (RSA). RSA is a method for performing three-dimensional (3-D) measurement and motion analysis using implanted markers and stereoscopic radiographs.

Position Statement

Investigational and Not Medically Necessary:

Radiostereometric analysis (RSA) is considered investigational and not medically necessary for all uses including, but not limited to the following:

  • Determination of migration and wear of orthopedic implants;
  • Assessment of spine and extremity fracture healing