Big private payer reverses course on cardiac PET/CT coverage

One of the largest private health insurers in the U.S. has gone from considering hybrid PET/CT for cardiac indications “experimental/investigational”—and thus not coverable—to displaying willingness to pay for the modality, evidently at the urging of two imaging associations.

The Society for Nuclear Medicine and Molecular Imaging publicized the change June 27, saying 39 million-enrollee Aetna reversed course on PET/CT a few days after SNMMI and the American Society of Nuclear Cardiology (ASNC) sent the insurance giant a pointed letter.

“Not covering hybrid PET/CT denies patient access to standard-of-care testing that is required to make life-saving clinical decisions,” SNMMI says in a press release conveying the gist of the letter. “SNMMI and ASNC’s recommendations regarding the role of PET/CT in the evaluation of coronary artery disease have been accepted by the American Medical Association (AMA) RVS Update Committee (RUC) and multiple payers, including CMS.”

SNMMI reports no direct response from Aetna but tells SNMMI members:

We are thrilled to communicate to our membership that within a few days of receiving our letter, Aetna reversed their non-coverage policy. SNMMI applauds this outcome and appreciates Aetna’s swift response.”

Aetna, a CVS Health company, covers close to 40 million individuals, according to the company.

Full SNMMI announcement here.