‘Partial victory’: Imaging advocates say Humana relenting on some PET/CT payment restrictions

Humana has dealt radiology providers a “partial victory” by relenting on some PET/CT payment denials while keeping others in place for now, imaging advocates revealed Tuesday.

It was back in November that the Louisville, Kentucky-based payer announced new restrictions around this modality in most instances, citing their “experimental” nature. Several groups opposed, launching a campaign to overturn the decision. The American Society of Nuclear Cardiology said Monday that it expected an update from Humana soon, following a recent internal review.

A day after the ASNC’s news, the Society of Nuclear Medicine and Molecular Imaging said Tuesday that Humana had “thankfully” reversed its decision to deny coverage for PET/CT imaging of gastric and esophageal oncologic indications.

“Humana's medical review panel will convene again in May to decide whether to cover PET/CT for cardiac/neurologic indications and SPECT/CT,” the society said in a news update published April 27. “SNMMI will continue to monitor this issue and will inform the membership once a decision is reached.”

The payment restrictions first took effect Feb. 4 and also pertain to total-body PET/CT for screening. SNMMI, ASNC and others have adamantly refuted Humana’s position, noting that many including CMS have accepted positron emission tomography with concurrently acquired CT as part of routine treatment.

“Implementation of Humana's revised policy would deny patients access to state-of-the-art imaging procedures that are the standard of care for supporting potentially lifesaving clinical decisions,” SNMMI said this week.