Cigna eliminates prior authorization requirements for some CT exams
On Monday, industrial insurance company Cigna reported it is no extended requiring prior authorization for particular CT examinations, such as these involving the heart, coronary arteries and bypass grafts with contrast.
Prior authorization is also eliminated for 3D impression write-up-processing, such as the analysis of cardiac structure and operate, as very well as venous structures, if done.
Cigna is also taking away the necessity for fractional flow reserve-CT. Noninvasive fractional flow reserve derived from coronary CT angiography is significantly used in individuals with coronary artery condition as a gatekeeper to the catheterization lab.
What is THE Impression
The change eliminates pre-authorization necessities for CPT code 75574 in all markets with Cigna eviCore health care other than for Hawaii, Puerto Rico and Guam. For coverage under the new coverage, individuals ought to have the two stable upper body soreness and an intermediate chance of coronary artery condition — for illustration, suspected or presumed stable ischemic heart condition.
The transfer drew praise from at minimum a single sector group, the Modern society of Cardiovascular Computed Tomography.
“The favorable coverage update exhibits that Cigna recognizes the use of CTA and FFR-CT as a entrance-line examination which can lead to improved patient outcomes.” reported Dr. Dustin Thomas, SCCT’s advocacy committee chair.
Prior authorization is a utilization management procedure used by some wellbeing insurance plan firms to identify if they will protect a prescribed technique, company or medication. The procedure is meant to act as a safety and price tag-conserving evaluate, although it has gained criticism from physicians for currently being high-priced and time-consuming.
THE Bigger Craze
Just last thirty day period, the Centers for Medicare and Medicaid Services finalized its interoperability and prior authorization rule, requiring Medicaid, CHIP and individual current market Skilled Health and fitness Strategies payers to build, apply and sustain software programming interfaces (APIs) that can empower provider accessibility to their patients’ knowledge and streamline the prior authorization procedure.
America’s Health and fitness Insurance policy Strategies spoke out versus the rule in a assertion from president and CEO Matt Eyles, blasting CMS for hurrying the finalization of the rule and indicating it was “shabbily and hastily built.” It in contrast the rule to placing “a plane in the air in advance of the wings are bolted on” since insurers are required to build these technologies without the important instructions.
The American Healthcare facility Association applauded the initiatives to remove boundaries to patient care by streamlining the prior authorization procedure, but it was unhappy that Medicare Edge designs have been left out.
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