One of the nation’s largest commercial insurers has reversed its policy restricting payment for certain PET/CT and SPECT/CT exams following criticism from nuclear medicine groups and providers.
Humana’s medical review panel met at the end of May and decided to change course, now reimbursing PET/CT scans for certain cardiac and neurologic indications along with SPECT/CT exams. Imaging experts and nuclear medicine groups have lambasted the insurer for denying coverage on the grounds such exams are “experimental” and “investigational.”
The Society of Nuclear Medicine and Molecular Imaging, which has been pushing for the change, said the new determination is “generous” and aligns with national coverage guidelines for 18F FDG-PET regarding infection and inflammation.
“We are grateful Humana took our concerns seriously and look forward to working together to expand SPECT/CT coverage,” SNMMI said in an announcement published Monday.
While Humana’s policy is only a draft document, it details coverage determinations for myocardial assessments, suspected prosthetic valve endocarditis, and SPECT/CT and PET/CT for neurologic indications.
Back in November, the Louisville, Kentucky, payer first announced its restrictions for most hybrid molecular imaging situations. The move quickly drew the ire of SNMMI and the American Society of Nuclear Cardiology, among others.
This past April, Humana gave some ground, announcing it would no longer deny coverage for PET/CT imaging of gastric and esophageal oncologic indications.
Matt joined Chicago’s TriMed team in 2018 covering all areas of health imaging after two years reporting on the hospital field. He holds a bachelor’s in English from UIC, and enjoys a good cup of coffee and an interesting documentary.