The new policy will go into effect on April 15. MRI and CT imaging would be approved in the hospital only under the following circumstances:
- Patient is under 10 years of age.
- Patient is under obstetrical observation.
- Patient requires perinatology services.
- Patient requires imaging related to transplantation services.
- Patient has a known contrast allergy.
- No other appropriate sites of service are available to undergo the advanced imaging procedure needed.
"All other high-tech radiology (imaging) procedures at a hospital-based imaging department or facility are considered not medically necessary," Cigna said.
Cigna's action is the latest example of insurer efforts to contain payments for advanced imaging. In March of last year, UnitedHealthcare implemented a policy that denied authorization for MRI and CT services in hospital outpatient settings for patients who do not qualify for particular exceptions; in 2017, Anthem Blue Cross Blue Shield of Indianapolis announced it would no longer automatically pay for CT and MRI exams performed in hospital outpatient settings.
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