Radiologists urge Cigna to rescind coverage restriction for key imaging procedure
Radiology groups recently wrote to health insurer Cigna, urging it to rescind a coverage policy relating to a key interventional procedure.
The Society of Interventional Radiology highlighted the advocacy push in a news update published Friday, with its concerns pertaining to policy 0539. Cigna is labeling peripheral nerve stimulation, or PNS, used to treat chronic pain, as medically unnecessary, with SIR and others questioning the rationale.
“SIR emphasized that PNS is an evidence-based, minimally invasive, image-guided therapy supported by randomized controlled trials, FDA-cleared technologies and a favorable safety profile,” the society said Feb. 13. “SIR urged Cigna to recognize PNS as medically necessary for appropriately selected patients with chronic pain and to align its coverage criteria with current clinical evidence and regulatory standards.”
The Bloomfield, Connecticut-based payer previously issued the policy in May, with the next review date slated for March 15. Cigna in its supporting documents cited concerns relating to implantable PNS and peripheral nerve field stimulation for the treatment of pain conditions. It noted potentially problematic use cases, such as electrical stimulation for headaches and occipital or trigeminal neuralgia. Such treatments typically involve using ultrasound or X-ray guidance to insert a needle near a nerve to inject an anesthetic or corticosteroid.
“Implantable peripheral nerve stimulation for the treatment of acute or chronic pain conditions is considered not medically necessary,” the payer said in its coverage policy, adding also that “Implantable peripheral nerve field stimulation is considered experimental, investigational or unproven for any indication.”
However, SIR and other radiology societies have railed against this rationale, noting strong evidence supporting PNS. They also wrote to Cigna in 2024, questioning previous payment policies.
“Peripheral nerve stimulation consistently results in improvement in pain, reduced disability, lower opioid use and improvement in quality of life for people affected by chronic pain,” they wrote two years ago. “By dismissing PNS as ‘not medically necessary,’ Cigna denies patients access to a treatment modality that has been recommended in treatment guidelines created by physician societies.”
Cigna is not alone in its efforts to restrict reimbursement for this interventional service. In November, SIR and other imaging groups said they were joining a multisociety initiative to fight payer policies pertaining to PNS. Others involved have included the American College of Radiology, American Society of Neuroradiology and American Society of Spine Radiology, altogether representing over 100,000 physicians.
They recently wrote joint letters to 5 of the 7 Medicare Administrative Contractors, urging them to rescind proposed reimbursement restrictions for peripheral nerve blocks and related procedures. In its new letter, SIR said it remains committed to advocating for patient access to safe, effective interventional therapies and will continue to engage with payers to “support appropriate coverage policies.”
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.