Humana curtails coverage for PET/CT, drawing 'adamant' disagreement from imaging advocates
One of the nation’s largest commercial insurers is restricting payment for hybrid PET/CT beginning in February, due to the “experimental” and “investigational” nature of the technology.
The American Society of Nuclear Cardiology recently publicized Humana’s coverage determination in an update to its members on Wednesday. It’s hoping to reverse the decision and is disputing the insurer’s notion that the technology is “not identified as widely used and generally accepted.”
“PET/CT represents state-of-the-art imaging for patients being evaluated for coronary artery disease. ASNC therefore adamantly disagrees with the Humana’s decision of non-coverage of cardiac PET-CT on the basis it is experimental,” President Sharmila Dorbala, MD, an associate professor of radiology at Harvard, wrote in a recent letter to the Louisville, Kentucky-based payer’s chief medical officer. “Non-coverage for hybrid PET/CT denies patient access to standard-of-care testing required to make life-saving clinical decisions,” she and colleagues added.
Humana said that its plan members will not be eligible for positron emission tomography with concurrently acquired CT in many instances. Those include cardiac, gastric, esophageal or neurologic indications, along with total body PET/CT for screening, the group said.
Dorbala noted that the ASNC and Society of Nuclear Medicine and Molecular Imaging’s recommendations on the use of PET/CT have been widely accepted by payers and the American Medical Association. She expressed similar opposition to another Humana decision to restrict coverage for SPECT/CT (CPT codes 78830 and 78832) for the same reasons, according to the Oct. 29 letter. SNMMI echoed its nuclear cardiology colleagues' concerns Friday, saying it "strongly disagrees" with the insurer's decision.
"We urge Humana to refrain from moving ahead with this proposed change," SNMMI President Alan Packard, PhD, told Radiology Business.
ASNC said that it had not received a response to the letter as of late Thursday. You can find the full Humana document on the coverage of fusion imaging here.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.