Computed Tomography (CAT Scan) and Computed Tomographic Angiography (CTA) of Extremity or Joint
Summary
Blue Cross and Blue Shield of Alabama policy L.6.01.400 covers CT of the knee for meniscal, ligament or tendon injury to rule out tear, fracture after injury, comparison for leg length or assessment of fracture union, possible or known septic arthritis, osteomyelitis or aseptic necrosis, patellofemoral pathology, and evaluation of loose body. CT of the shoulder is medically necessary when an MRI is not feasible for suspected rotator cuff injury, suspected labral tear, known fracture or subluxation, or possible axillary mass, and for pre-operative planning for joint replacement (CT arthrogram). CT of the temporomandibular joint is medically necessary when signs and symptoms of TMJ disease are present and MRI is not feasible or not tolerated. CT of the hip is medically necessary when x-rays are nondiagnostic and MRI is not feasible for impaired range of motion, gait abnormality, locking or snapping, occult or stress fractures, acute or chronic soft-tissue injuries or tumors, and evaluation of avascular necrosis. CT of the upper extremity is medically necessary for fracture or fracture fragments, stress fracture, complex fractures for therapy planning, possible nonunion, and trauma when x-rays are negative and there is high clinical suspicion of bony injury. CT of the lower extremity is medically necessary for foot-tarsal deformity or coalition, fractures as above, and trauma when x-rays are negative and there is high clinical suspicion of bony injury. Additional upper and lower extremity or joint indications apply when MRI is not feasible, including osteomyelitis, palpable mass or possible bone tumor, assessment of prosthetic position and alignment, septic joint, synovitis, and pre-operative planning for joint replacement, and ankle impingement syndrome for the lower extremity. CT of the hip joint is medically necessary for confirmation of subtle femoroacetabular impingement morphology for pre-operative planning for hip arthroscopy when MR arthrography or local anesthetic injection into the joint is equivocal. CT of an extremity or joint is not medically necessary for all other indications, including screening of asymptomatic patients. CT angiography of the upper extremity is medically necessary for suspected occlusion or stenosis, aneurysm or AVM of upper extremity arteries, venous aneurysm, pseudoaneurysm, and evaluation of penetrating trauma with suspected vascular injury. CT angiography of the lower extremity is medically necessary for suspected occlusion or stenosis (peripheral arterial vascular disease), femoral or popliteal artery aneurysm, popliteal trauma, fibular transfer graft, venous aneurysm, aneurysm or AVM of lower extremity arteries, pseudoaneurysm, and evaluation of penetrating trauma with suspected vascular injury. CT angiography of an extremity or joint is not medically necessary for all other indications, including screening of asymptomatic patients. The Code Reference was updated on 10/01/2026 to add ICD-10 codes M86.8X11 through M86.8X79 for osteomyelitis. RadSite was added as an imaging accreditation body on 11/01/2025.
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