Radiology societies urge commercial insurers to align with Medicare on payment policy for key procedure
Radiology societies are urging several commercial insurers to realign their payment policies for a key procedure to match with Medicare.
Nearly a dozen national medical groups voiced their concerns in a May 1 letter to Humana, Aetna and others. Their frustration stems from policies pertaining to coverage for a minimally invasive procedure to treat compression fractures in the vertebral body.
The American College of Radiology—alongside similar groups representing neuro, spine and interventional radiologists—criticized payer policies that forbid coverage for such surgery in the initial days following a fracture.
“We believe limiting surgical procedures to fractures over six weeks old should be revised/eliminated as this requirement has the potential to negatively impact patient outcomes and providers’ ability to deliver evidence-based, appropriate spinal care to all patients,” ACR et al. wrote. “Notably, recent literature supports this suggestion with positive impacts to patient biomechanical changes, pain scores, quality of life metrics, mortality rates, and long-term economic benefits.”
In a May 5 news post, the college estimated that “at least” six commercial insurers now require four to six weeks of conservative management before patients can receive a percutaneous vertebral augmentation procedure. However, this contradicts the medical literature, along with Medicare payment policies in place since 2021. Delaying surgical management in an often frail and elderly patient population can result in prolonged bed rest, immobility and the use of narcotics—potentially leading to decreasing physical conditions, poor pulmonary function and increased risk of death.
Insurers targeted in the effort also include Cohere Health, Evicore, Health Care Services Corp. and Aim Specialty Health. The latter has already responded to the letter “and is reviewing the issue,” the ACR reported Friday.
Meanwhile, other medical groups joining the campaign are the American Academy of Pain Medicine, the American Society of Anesthesiologists, and the North American Spine Society.
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.