Anthem Blue Cross Connecticut MED.00105 Bioimpedance Spectroscopy Devices for the Detection and Management of Lymphedema Form

This document addresses the use of bioimpedance spectroscopy, a device which uses impedance ratios to measure extracellular fluid volume differences between limbs to aid in the clinical assessment of lymphedema.

Note: Please see the following related document for additional information:

• CG-DME-06 Compression Devices for Lymphedema

Position Statement

Investigational and Not Medically Necessary:

The use of bioimpedance spectroscopy testing in the assessment, diagnosis, or management of individuals with known or suspected lymphedema is considered investigational and not medically necessary.