ASNC Addressing CT Coverage Policy Issues with Humana, United Healthcare
ASNC is moving quickly to resolve two issues that have arisen around insurers' activity around CT coverage.Here is an overview of the issues and how ASNC is advocating for resolution:
Humana Limiting Coverage of PET-CT Hybrid ImagingASNC's Health Policy and Cardiovascular PET Committees are working together to address a coverage limitation announced by Humana last week. According to the policy update, Humana will implement revised coding for CPT code 78433 to forgo coverage of PET with concurrently acquired CT for cardiac indications, as the insurer considers it to be “experimental/investigational.” The stated reason for the limitation, slated to go into effect Feb. 4, 2021, is that it is “not identified as widely used or generally accepted [for this use] as reported in nationally recognized peer-reviewed medical literature published in the English language.” ASNC opposes this decision because these procedures are unequivocally NOT experimental and are indeed widely performed. The majority of PET scanners manufactured today are PET-CT machines.
United Healthcare's Prior Approval ProcessASNC's Health Policy Committee remains concerned about United Healthcare's inefficient prior approval process for CT and nuclear cardiology testing. When ASNC President-elect Randall Thompson, MD, FASNC, Health Policy Committee Chair David Wolinsky, MD, MASNC, and staff met with United Healthcare leaders in May, the insurer indicated that it was not mandating imaging modalities; however, United Healthcare has continued communicating that it expects coronary CT angiography to replace functional imaging in many patients. ASNC is working in conjunction with other societies to obtain written clarification of the insurer's policy. ASNC objects to any test substitution policy and opposes barriers to care that increase administrative burdens on physicians and slow the delivery of timely testing and treatment.
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