American College of Radiology joins fight against Humana’s much-maligned PET/CT payment restrictions

The American College of Radiology has joined the battle against a much-maligned decision by Humana to restrict coverage for PET/CT imaging.

Back in October, the nation’s fourth largest commercial insurer notified plan members that they would not be eligible for positron emission tomography with concurrently acquired CT in many instances. Those include cardiac, gastric, esophageal or neurologic indications, along with total body PET/CT for screening.

Humana claimed that the technology is “experimental” and ““not identified as widely used and generally accepted,” drawing swift rebuke from nuclear medicine groups. Now, the college is joining in and asking the Louisville, Kentucky-based payer to reverse course.

“The ACR strongly disagrees with Humana’s proposed coverage determination to exclude hybrid PET imaging for cardiac and several other indications as ‘experimental’ and ‘investigational,’” CEO William Thorwarth Jr., MD, wrote to Humana’s chief medical officer Dec. 4. “There is ample evidence in the published literature as well as published clinical guidelines and appropriate use criteria supporting the use of hybrid PET/CT that is widely accepted by many payers, including CMS.”

Thorwarth also cited practice recommendations from the Society of Nuclear Medicine and Molecular Imaging and American Society of Nuclear, Cardiology, both adamant opponents of the decision. He closed by urging Humana to can the changes, along with similar restrictions on SPECT/CT.

“Implementing this revised policy will deny patients access to state-of-the-art imaging procedures that are the standard-of-care for making potentially lifesaving clinical decisions,” he wrote to William Shrank, MD. “We respectfully insist this new policy be reversed.”