Anthem Blue Cross Connecticut MED.00116 Near-Infrared Spectroscopy Scanning for Brain Hematoma Screening Form

This document addresses the use of near-infrared spectroscopy (NIRS) for the screening and detection of brain hematomas and intracranial bleeding. The InfraScanner^® (InfraScan, Inc., Philadelphia, PA) handheld brain scanner unit uses NIRS for the detection of possible development of intracranial hematomas in high-risk individuals, such as those with head trauma.

Position Statement

Investigational and Not Medically Necessary:

Near-infrared spectroscopy scanning for brain hematoma screening (that is, InfraScanner) is considered investigational and not medically necessary for all indications.