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To date, the ICACTL is aware that the following insurers have adopted
computed tomography reimbursement directives, and provides this
information as a service to the CT community. If you are aware
of additional payment policies, please email Lawrence
Williams.
Anthem
Health Plans Of Virginia, Inc. d/b/a Anthem Blue Cross and Blue
Shield and its HMO Affiliates
Virginia
April 2008
Anthem Health Plans of Virginia, Inc. d/b/a Anthem Blue Cross
and Blue Shield and its HMO affiliates, have released the following
announcement:
- Accreditation
requirements included to promote consistent, quality diagnostic
imaging services
- Standards
set by appropriate societal organizations have been adopted
and will be utilized to establish a certification process
for all imaging providers.
- Participating
provider currently performing or conducting any CT, CTA, MRI,
MRA, MRS, PET and/or Nuclear/Nuclear Cardiology studies shall
obtain accreditation from the American College of Radiology
(ACR) or Intersocietal Accreditation Commission (IAC) within
one year of the effective date of this Agreement. Accreditation
is required for each piece of equipment utilized in such studies
no later than April 1, 2009.
- Participating
provider not currently performing any CT, CTA, MRI, MRA, MRS,
PET and/or Nuclear/Nuclear Cardiology studies, but at any
point purchases or leases equipment and begins performing
such studies, participating provider shall obtain accreditation
from the American College of Radiology (ACR) or Intersocietal
Accreditation Commission (IAC) for each piece of equipment
utilized in such studies within one year of the date such
studies are first conducted.
- Additional
communication will follow on diagnostic imaging services,
equipment, licensure and/or accreditation.
DIAGNOSTIC IMAGING SERVICES
Within
30 days of receipt of a written request, participating provider
shall provide to Health Plan such information as may be
requested concerning diagnostic imaging services, equipment,
licensure and/or accreditation.
Providers
that perform or conduct any CT, CTA, MRI, MRA, MRS, PET
and/or Nuclear/Nuclear Cardiology studies shall be accredited
by the American College of Radiology (ACR) or Intersocietal
Accreditation Commission (IAC) for each piece of equipment
utilized in such studies.
United
Healthcare
January 2007; revised 8/21/2008
NEWLY UPDATED, 8/21/2008
- UnitedHealth Group (UnitedHealthcare) has released an announcement
requiring all freestanding imaging facilities and physician
offices performing computed tomography procedures to apply for
accreditation, and has extended its original
deadline (3/1/2008) for this requirement until the fourth quarter
of 2009. Please note:
UnitedHealthcare has stated that freestanding imaging sites
and/or provider clinics with imaging equipment who have not
received accreditation by the above deadline, but have submitted
their application to the ICACTL, will be in a pending status
and will be considered in compliance with the accreditation
program.
Would
you like to know more about the UnitedHealthcare requirement?
For the details and official guidelines from UnitedHealthcare,
please visit their website section for Imaging
Accreditation. [Go to UnitedHealthcareOnline.com
> Clinician Resources > Radiology, and select
Imaging Accreditation from the vertical menu bar on the
left.] Get answers to common questions about the UnitedHealthcare
policy in Imaging
Accreditation: Frequently Asked Questions. >>
Mountain
State Blue Cross Blue Shield
West Virginia and Washington County, Ohio
November 2007
Starting
in November of 2007, Mountain State Blue Cross Blue Shield (Mountain
State) will initiate credentialing criteria that pertains
to outpatient general computed tomography (CT) services and
cardiac computed tomography angiography (CCT-A) services.
Credentialing details may also be obtained by visiting the provider
tab of Mountain State's website at www.msbcbs.com.
Outpatient
CT Provider Types and Credentialing Criteria:
- Hospitals
that provide outpatient CT and/or CCT-A services
- Free
standing imaging facilities that provide outpatient CT and/or
CCT-A services
- Physician
offices that provide outpatient CT and/or CCT-A services
Accreditation:
A copy of a current letter or certificate of accreditation,
both of which will be inclusive of the accreditation expiration
date. Accepted accreditations are:
- The
American College of Radiology (ACR) for free standing and
physician office based outpatient CT scanners
- The
Intersocietal Commission for the Accreditation of Computed
Tomography Laboratories (ICACTL) for free standing and
physician office based outpatient CT scanners
- The
Joint Commission on Accreditation of Healthcare Organizations
(JCAHO) for hospital based outpatient CT scanners
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