Radiology societies say MACs’ refusal to cover imaging guidance for key procedure poses safety risk

Four radiology societies believe that Medicare Administrative Contractors’ refusal to cover imaging guidance for a key procedure poses a risk to patient safety. 

The American College of Radiology, Society of Interventional Radiology and others recently submitted a letter to five of the seven MACs. Their concern stems from lack of coverage for ultrasound used to guide trigger-point injections, a minimally invasive medical procedure for treating painful knots in muscles. 

Most MACs have labeled such imaging assistance as “investigational.” But radiologists have countered that it is “vital to ensure the needle and injectate are placed safely and accurately within certain anatomical locations.”

“In an effort to ensure that [trigger point injections] do not pose a safety risk for patients, we urge the MACs to cover ultrasound guidance in specific regions where an inaccurately placed injection could pose a significant safety risk,” ACR, SIR, the American Society of Neuroradiology, the American Society of Spine Radiology and others wrote Oct. 9. 

Imaging societies emphasized the importance of ultrasound guidance in areas near high-risk tissues or in deeper anatomic locations. These include the scalene and other neck muscles, the thoracic region overlying the lungs, and the piriformis and other deep gluteal muscles. On the latter, for example, failure to use imaging assistance could result in damage to the sciatic nerve, ACR et al. noted. 

To back their claims, radiology groups cited multisociety guidelines published in July. The document notes that ultrasound can help to better visualize neurovascular structures and may result in more accurate targeting of trigger point injections in deeper anatomic locations. 

“We encourage the MACs to review this new guideline and the evidence cited therein, which supports the use of ultrasound guidance for TPIs in specific anatomic locations,” the groups wrote. “Without ultrasound guidance availability, diagnostic relevance will be lost, and the safety of certain TPI injections (e.g., anterior neck muscles, deep gluteal muscles, chest wall, as described above) will be greatly reduced.”

MACs receiving the letter included Celerian Group Company Administrators LLC, Noridian Healthcare Solutions LLC, National Government Services Inc., Palmetto GBA, and Wisconsin Physicians Service Insurance Corp. 

The American Academy of Physical Medicine and Rehabilitation, American Society of Anesthesiologists, American Society of Regional Anesthesia and Pain Medicine, International Pain and Spine Intervention Society, North American Neuromodulation Society and North American Spine Society also signed the message. ACR called attention to the matter in a news update published Thursday.