Imaging advocates offer guidance after reported spate of SPECT/CT payment denials

Radiology industry advocates are offering guidance after a recent rash of SPECT/CT payment denials.

The Society of Nuclear Medicine & Molecular Imaging said Thursday that it’s received “many complaints” from the field pertaining to various commercial payers. SNMMI has now created a sample response letter to help providers fight this payment roadblock.

“We believe there is a fundamental lack of understanding in commercial payers’ medical review panels regarding the everyday clinical value of SPECT/CT to physician clinicians across all geographic regions and at all major hospital systems in the United States,” the society said in a June 3 news update. “We hope that the reasons stated and literature cited in this letter will [emphasize] the value of SPECT/CT and its need for commercial payer coverage.”

Health insurers including Humana have recently labeled this nuclear imaging technique “investigational” and not medically necessary in certain scenarios. This is despite “significant scientific scrutiny” prior to the Centers for Medicare & Medicaid Services reimbursing for these exams, SNMMI noted.

The Reston, Virginia-based advocacy group said the medical necessity letter is the result of months of work from its Coding & Reimbursement and Government Relations committees. Several industry partners also reviewed the document, which can be accessed for free here.

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