June 30, 2021

Humana Updates PET/CT Coverage Policy

Advocacy efforts by the Society of Nuclear Medicine and Molecular Imaging (SNMMI) supported by the American College of Radiology® (ACR®) have resulted in a Humana draft policy that indicates that the insurer now will cover PET/CT imaging for cardiac/neurologic indications. The new policy is consistent with the Centers for Medicare and Medicaid Services (CMS) coverage for FDG-PET for infection and inflammation. In addition to the expanded PET/CT coverage, Humana now will also cover SPECT/CT for for preoperative localization of parathyroid adenomas.

In a Dec. 4 letter, the ACR expressed concern about the decision by Humana to deny coverage of certain PET/CT exams on the basis that it is “experimental/investigational” and “not identified as widely used.” Specific indications listed for non-coverage included cardiac indications, gastric or esophageal oncologic indications, neurologic indications and total body PET/CT for screening. The ACR said Humana’s decision denied patient access to standard-of-care testing that is required to make lifesaving clinical decisions.

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