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Advocacy Win: Aetna Reverses Cardiac PET/CT Non-coverage Policy
ASNC is pleased to report that Aetna has reversed its policy of non-coverage for cardiac PET/CT. The payer's policy change followed receipt of a joint letter from ASNC and the Society of Nuclear Medicine and Molecular Imaging (SNMMI).
How This Advocacy Win Unfolded
Earlier this year, ASNC received reports from members that Aetna was refusing to cover PET/CT scans (CPT codes 78429-78431, 78433) because the payer considered the scans to be “experimental/investigational” and “not identified as widely used and generally accepted for the proposed uses as reported in nationally recognized peer-reviewed medical literature.” Aetna's policy stated, "The fusion of PET and CT imaging into a single system (PET/CT fusion) is considered experimental and investigational for cardiac indications; a PET scan without CT is adequate to evaluate the myocardium."ASNC, joined by SNMMI, sent a letter "adamantly" diagreeing with the policy. "This decision not to cover hybrid PET/CT denies patient access to standard-of-care testing that is required to make life-saving clinical decisions," the societies wrote.
ASNC and SNMMI urged Aetna to reconsider the non-coverage policy, emphasizing that the position was inconsistent with the current standards and practice of cardiac PET across the U.S. The letter cited the societies' recommendations on the role of PET/CT in the diagnosis and evaluation of coronary artery disease. These recommendations have been accepted by the American Medical Association RVS Update Committee, multiple payers and Medicare.
ASNC is committed to ensuring coverage policies follow current, peer-reviewed guidelines and literature. We ask members to report non-coverage issues to info@asnc.org.