October 3, 2023


Built Business Tough

Cigna eliminates prior authorization requirements for some CT exams

On Monday, commercial insurer Cigna stated it is no more time demanding prior authorization for specified CT examinations, which includes individuals involving the heart, coronary arteries and bypass grafts with contrast.

Prior authorization is also removed for 3D graphic write-up-processing, which includes the evaluation of cardiac structure and perform, as very well as venous constructions, if carried out. 

Cigna is also removing the prerequisite for fractional flow reserve-CT. Noninvasive fractional flow reserve derived from coronary CT angiography is increasingly used in individuals with coronary artery condition as a gatekeeper to the catheterization lab.

What’s THE Effect

The adjust eliminates pre-authorization prerequisites for CPT code 75574 in all marketplaces with Cigna eviCore healthcare apart from for Hawaii, Puerto Rico and Guam. For coverage under the new policy, individuals will have to have the two stable upper body soreness and an intermediate danger of coronary artery condition — for instance, suspected or presumed stable ischemic heart condition.

The shift drew praise from at minimum a single sector firm, the Modern society of Cardiovascular Computed Tomography.

“The favorable policy update demonstrates that Cigna recognizes the use of CTA and FFR-CT as a front-line check which can lead to improved client results.” stated Dr. Dustin Thomas, SCCT’s advocacy committee chair.

Prior authorization is a utilization administration procedure used by some health and fitness insurance coverage firms to decide if they will cover a approved method, support or medicine. The procedure is supposed to act as a security and price-preserving evaluate, whilst it has acquired criticism from medical professionals for staying high-priced and time-consuming.

THE More substantial Trend

Just very last month, the Facilities for Medicare and Medicaid Services finalized its interoperability and prior authorization rule, demanding Medicaid, CHIP and individual industry Skilled Wellness Programs payers to develop, put into practice and sustain software programming interfaces (APIs) that can permit provider obtain to their patients’ facts and streamline the prior authorization procedure.

America’s Wellness Insurance policy Programs spoke out against 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 manufactured.” It compared the rule to putting “a plane in the air prior to the wings are bolted on” since insurers are necessary to develop these technologies devoid of the essential guidelines.

The American Clinic Association applauded the initiatives to take out obstacles to client treatment by streamlining the prior authorization procedure, but it was let down that Medicare Advantage programs were left out.

Twitter: @JELagasse
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