August 19, 2021

Anthem Expands Pediatric Access to Hospital-Based Imaging

As a result of thoughtful discussions between the American College of Radiology® (ACR®), the Society of Pediatric Radiology (SPR) and Anthem, the insurer recently updated its policy, “Site of Care: Advanced Radiologic Imaging,” to allow patients under age 19 the option of receiving advanced diagnostic imaging in the hospital setting, effective Aug. 19. Anthem’s previous policy limited access to hospital-based advanced imaging to children age 10 and younger.

The ACR and SPR sent a letter to Anthem in April urging the insurer to expand its site of care medically necessary criteria to allow children up to 19 years of age to have high-tech imaging procedures performed and monitored at sites with appropriate pediatric imaging expertise, including hospital-based imaging. The societies engaged in a productive dialog with the insurer on Aug. 11, and Anthem made the decision to update the policy shortly thereafter.

The updated policy will have a positive impact on the quality and safety of pediatric care for children and adolescents undergoing advanced outpatient imaging studies. Pediatric patients up to age 19 now have access to hospital-based imaging centers that are commonly staffed with pediatric specialists. This includes specialized pediatric radiologists, who are the most experienced physicians for monitoring and interpreting these advanced imaging studies, as well as the technologists and nurses who are specially trained to interact with and perform diagnostic computed tomography scan and magnetic resonance imaging examinations for the pediatric population.

Questions about this policy should be directed to Katie Keysor, ACR Senior Director of Economic Policy.