An imaging advocacy group has issued a new model coverage policy, hoping to spur insurers to more consistently and correctly cover PET scans for certain indications.
The American Society of Nuclear Cardiology announced the development Sept. 7, contending that there are several clinical indications where cardiac positron emission tomography should be “universally covered” by all payer types. Leaders have compiled current clinical evidence, urging health insurers to quash “unnecessary” prior authorization requirements ASNC believes can lead to “dangerous care delays and denials.”
“Unfortunately, some payers are not fully aware of the extensive literature supporting cardiac PET in many clinical scenarios, including the newer indications for evaluating coronary microvascular dysfunction, cardiac sarcoidosis and inflammation, and cardiovascular infection,” ASNC President Mouaz H. Al-Mallah, MD, who also is director of cardiovascular PET at Houston Methodist, said in a statement. “ASNC’s new model coverage policy describes each clinical situation where a cardiac PET study is currently indicated, including symptoms, references and cross-references to the appropriate use criteria.”
A team of top authorities on the modality developed the document, which ASNC published Sept. 5 in the Journal of Nuclear Cardiology [1]. It also details corresponding ICD-10 codes to aid referring physicians and billing staffers in seeking payment for cardiac PET. Find the full model coverage policy at the link below.
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.