December 02, 2020

ACR and SPR Request Expansion of Pediatric Hospital-Based Imaging

The American College of Radiology® (ACR®) teamed with the Society of Pediatric Radiology (SPR) on a Nov. 24 letter to Cigna, 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.

Cigna’s “Site of Care: High Technology Radiology” policy, effective Aug. 1, 2020, requires with limited exceptions, high-tech imaging services to be performed in freestanding imaging centers rather than hospital outpatient departments. The pediatric exception applies only to children up to age 10. The ACR and SPR expressed significant concerns with Cigna’s decision. This new policy will have a profoundly negative impact on the quality and safety of pediatric care for children and adolescents undergoing advanced outpatient imaging studies. Under this Cigna policy, pediatric patients older than 10 years of age will be directed away from 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 examinations for the pediatric population. The cut-off of 10 years old is artificial, and many diseases of childhood extend into adolescence.

The ACR received a preliminary response from Cigna on Nov. 30 confirming receipt of the letter and indicating that the request is currently under review.

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