Anthem Blue Cross Connecticut Commercial Clinical Policy

Anthem Blue Cross Connecticut SURG.00148 Spectral Analysis of Prostate Tissue by Fluorescence Spectroscopy Form

Effective Date

04/12/2023

Last Reviewed

02/16/2023

Original Document

  Reference



SURG.00148 Spectral Analysis of Prostate Tissue by Fluorescence Spectroscopy

Subject:

Description/Scope

This document addresses the use of spectral analysis of prostate tissue by fluorescence spectroscopy, which involves using fiber optics to differentiate between normal prostate tissue and suspicious prostate tissue.

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

  • CG-MED-45 Transrectal Ultrasonography
  • CG-SURG-98 Prostate Biopsy using MRI Fusion Techniques
  • SURG.00107 Prostate Saturation Biopsy

Position Statement

Investigational and Not Medically Necessary:

Spectral analysis of prostate tissue by fluorescence spectroscopy is considered investigational and not medically necessary for all indications.