June 01, 2023

No Cost Sharing Is Allowed for Preventive Services

The American College of Radiology® (ACR®) is concerned that some commercial payers are requiring patient co-payments for United States Preventive Services Task Force (USPSTF)-endorsed preventive services. Lung Cancer Screening programs alerted ACR that some payers are notifying imaging centers during prior authorization that cost sharing will apply for screening for lung cancer with low-dose computed tomography (LDCT). The payer action may be related to a recent Texas federal court ruling that invalidated the Affordable Care Act (ACA) requirement that USPSTF-approved preventive services be covered at no cost to the patient. However, the ruling has been appealed and it is not in effect; the College previously reported that it will continue to monitor this court ruling.

If your screening program or facility has received notification of patient copayments, the ACR suggests you share the following statement with the payer pre-authorization representative:

“The federal government appealed the decision on May 15, and the Fifth Circuit Court of Appeals issued an administrative stay of the district court’s ruling. The federal government can continue enforcing the preventive services requirement while the Fifth Circuit considers the Department of Justice’s motion for a stay pending appeal. Learn more about the litigation challenging the ACA’s preventative services requirements.”

Please notify Katie Keysor, ACR Senior Director, Economic Policy, or Alicia Blakey, ACR Principal Economic Analyst, if you are experiencing problems with prior authorization or if patients are experiencing cost sharing for preventive screening services, including lung cancer screening, mammography or CT Colonography.