February 25, 2021

Cigna Expands Pediatric Access to Hospital Based Imaging

In response to a letter from the American College of Radiology® (ACR®) and the Society of Pediatric Radiology (SPR), Cigna, one of the nation’s largest commercial insurers, recently expanded accessibility of hospital-based imaging for pediatric patients. The Nov. 24 letter urged the insurer to expand its site of care medical necessity 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 ACR and SPR are extremely appreciative of Cigna’s decision to update its “Site of Care: High Technology Radiology” policy, effective Feb. 22. The policy, originally effective Aug. 2020 requires, with limited exceptions, high-tech imaging services to be performed in freestanding imaging centers rather than hospital outpatient departments. The pediatric exception previously applied only to children up to age 10. The revised policy allowing children up to age 19 to access hospital-based advanced imaging will have a positive impact on the quality and safety of pediatric care for children and adolescents. Hospitals often staff 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.

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