February 20, 2020

Cigna Announces Site of Care Coverage Policy for High-tech Imaging

Cigna, the nation’s fourth largest health care insurer, recently announced a new site of care medical coverage policy for advanced diagnostic imaging services. The policy, slated to go into effect on April 15, 2020, applies to magnetic resonance (MR) and computed tomography (CT) imaging. It outlines limited circumstances for the medical necessity of imaging performed in a hospital setting.

Circumstances where MR and CT imaging in the hospital setting would be approved include:

  • For patients under 10 years of age
  • For obstetrical observation patients
  • For perinatology services
  • For imaging related to transplantation services
  • For patients with a known contrast allergy
  • When no other appropriate alternative sites of service are available for the patient to undergo the prescribed advanced imaging procedure, including circumstances that would adversely impact or delay patient care

All other CT and MR services at a hospital-based imaging facility are considered not medically necessary.

For more information, contact Kathryn Keysor, American College of Radiology® senior director of economics and health policy, at kkeysor@acr.org.