Anthem Blue Cross Connecticut RAD.00057 Near-Infrared Coronary Imaging and Near-Infrared Intravascular Ultrasound Coronary Imaging Form

Effective Date

09/27/2023

Last Reviewed

08/10/2023

Original Document

  Reference



This document addresses near-infrared coronary imaging and near-infrared intravascular ultrasound coronary imaging. Near-infrared coronary imaging, also referred to as near-infrared spectroscopy (NIRS), was created for the near-infrared examination of coronary arteries to detect plaques with large lipid cores in individuals undergoing cardiac angiography. Subsequently, near-infrared intravascular ultrasound coronary imaging was developed for the near-infrared examination of coronary arteries during invasive coronary angiography in combination with intravascular ultrasound (IVUS) examination of coronary intravascular pathology.

Position Statement

Investigational and Not Medically Necessary:

Near-infrared coronary imaging is considered investigational and not medically necessary for all indications.

Near-infrared intravascular ultrasound coronary imaging is considered investigational and not medically necessary for all indications.