The American Society of Nuclear Cardiology (ASNC) has developed a new model coverage policy that defines several categories of clinical indications where cardiac PET and myocardial blood flow assessment should be universally covered by Medicare contractors, Medicaid programs and private payers. By compiling the current evidence supporting medical necessity for each indication, ASNC aims to help payers eliminate unnecessary prior authorization requirements that can lead to dangerous care delays and denials.
FAIRFAX, Va., Sept. 7, 2023 /PRNewswire/ -- To encourage consistent and correct coverage policies for cardiac positron emission tomography (PET), the American Society of Nuclear Cardiology (ASNC) has developed a new model coverage policy that defines several categories of clinical indications where cardiac PET and myocardial blood flow assessment should be universally covered by Medicare contractors, Medicaid programs and private payers. By compiling the current evidence supporting medical necessity for each indication, ASNC aims to help payers eliminate unnecessary prior authorization requirements that can lead to dangerous care delays and denials.
"The ASNC Model Coverage Policy: 2023 Cardiac Positron Emission Tomography," published online today in the Journal of Nuclear Cardiology, also will help physicians to advocate effectively for their patients' access to appropriate cardiovascular testing. When faced with a care denial, physicians may reference the model coverage policy in discussions with payers.
"Unfortunately, some payers are not fully aware of the extensive literature supporting cardiac PET in many clinical scenarios, including the newer indications for evaluating coronary microvascular dysfunction, cardiac sarcoidosis and inflammation, and cardiovascular infection," says ASNC President Mouaz H. Al-Mallah, MD, MSc, FASNC (Houston Methodist DeBakey Heart and Vascular Center, Texas). "ASNC's new model coverage policy describes each clinical situation where a cardiac PET study is currently indicated, including symptoms, references and cross-references to the appropriate use criteria."
The document also provides tables detailing how the clinical indications for cardiac PET correspond to the ICD-10 Clinical Modification codes. In this way, ASNC intends for the model coverage policy to function as a helpful resource for the cardiology community, referring physicians and their billing/coding staff.
"The ASNC Model Coverage Policy: 2023 Cardiac Positron Emission Tomography" was developed by a team of leading authorities in cardiac PET imaging and myocardial blood flow assessment. The writing committee's co-chairs were Stephen Horgan, MD, PhD (Morristown Medical Center, Morristown, New Jersey), and Rupa Sanghani, MD, FASNC (Rush University Medical Center, Chicago, Illinois).
ABOUT ASNC
The American Society of Nuclear Cardiology and its more than 4,900 members have been improving cardiovascular outcomes through image-guided patient management for more than 30 years. As the only society dedicated solely to the field of nuclear cardiology, ASNC establishes standards for excellence in cardiovascular imaging through the development of clinical guidelines, professional medical education, advocacy and research development. ASNC provides peer-reviewed original articles through its official publication, The Journal of Nuclear Cardiology. For more information, visit http://www.asnc.org.
Media Contact
Kathy Boyd David, ASNC, 717-422-1181, [email protected], www.asnc.org
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