Nuclear medicine groups oppose Humana PET/CT policy

By staff writers

November 12, 2020 -- Groups that represent nuclear medicine physicians have voiced their opposition to a decision by Humana to not widely reimburse for PET/CT procedures performed for myocardial perfusion.

The Society of Nuclear Medicine and Molecular Imaging (SNMMI) said it learned of Humana's decision on November 6 to deny coverage for PET/CT procedures performed under current procedural terminology codes 78429-78433, which covered PET myocardial perfusion scans, with and without concurrent CTE. Humana declined to pay for the procedures because it claimed they were "experimental/investigational" and "not identified and widely used."

In opposing the decision, the SNMMI pointed to guidelines it has issued, as well as those issued by the American Society of Nuclear Cardiology, detailing the components required to perform PET/CT nuclear cardiology procedures.

"Nearly all commercially available PET scanners are now hybrid PET/CT systems, and these newer systems have numerous other improvements compared to older models," the SNMMI noted. "With this policy, Humana is thus requiring its members to provide cardiac PET services using less advanced instrumentation than is currently available."

Copyright © 2020

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