Humana partially reverses PET/CT policy

By staff writers

April 28, 2021 -- Humana will begin covering PET/CT imaging for gastric and esophageal oncologic indications, a sign that the modality may be shifting out from under current procedural terminology (CPT) codes that list it as "experimental/investigational," according to the Society of Nuclear Medicine and Molecular Imaging (SNMMI).

PET/CT (CPT codes 78429-78433) and SPECT/CT (CPT codes 78830 and 78832) are largely still not covered by Humana, including for cardiac and neurologic indications, as well as total body PET/CT with the uExplorer system from United Imaging for cancer screening.

SNMMI began lobbying Humana to change its coding policy last year and align with evidence in peer-reviewed literature supported by the U.S. Centers for Medicare and Medicaid Services and the American Medical Association that suggests PET/CT and SPECT/CT procedures are standard of care.

Humana's medical review panel will convene again in May to decide whether to cover PET/CT for cardiac/neurologic indications and SPECT/CT.

Copyright © 2021

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