May 26, 2022

ACR and RBMA Ask Payers for Prior Authorization Flexibility Due to Contrast Media Shortage

Radiology practices around the United States continue to feel the impact of the shortage of iodinated contrast media used in many imaging exams due to COVID-19 shutdowns in Shanghai. GE Healthcare’s Omnipaque and Visipaque contrast media were added to the U.S. Food and Drug Administration (FDA) drug shortage list May 9.

In an effort to ensure radiology practices have sufficient flexibility to change imaging orders as needed, the American College of Radiology® (ACR®) and the Radiology Business Management Association (RBMA) have written letters to private insurers and radiology benefit management (RBM) companies requesting changes in prior authorization procedures. The organizations asked the insurers and RBMs to allow flexibilities in the prior authorization to allow providers the option of changing patient orders for CT scans with contrast as needed, without having to repeat the prior authorization process and potentially delay patient care.

The ACR and RBMA requested an immediate change to prior authorization policies to allow for the prior authorization of “families” of CPT® codes. For many imaging services, families of these codes exist to describe similar services that are unique with respect to the complexity of the examination or the use of intravenous contrast. For example, the CT head family of codes would consist of CT head without contrast (CPT code 70450), CT head with contrast (CPT code 70460), and CT head with and without contrast (CPT code 70470). Allowing imaging providers the flexibility to change orders as needed without the burden of an additional prior authorization will permit streamlined and efficient patient care without unnecessary delays.

While the focus of the letter was the immediate need for flexibility, the ACR and RBMA believe that prior authorization of families of CPT codes is a best practice that should be followed by all insurers and RBM companies. CPT code-specific prior authorization allows the imaging provider to only perform the exam exactly as previously ordered and authorized, not to tailor the exam to the patient/clinical situation and best answer the diagnostic question.

The ACR has developed a resource page about the contrast media shortage. For questions regarding payer and RBM policies, please contact Katie Keysor, ACR Senior Director, Economic Policy.