The Society of Nuclear Medicine and Molecular Imaging (SNMMI) has published a letter template for healthcare providers to use to contest coverage denials of SPECT/CT exams.
Although the 2020 Current Procedural Terminology (CPT) SPECT/CT codes have been significantly revised, many commercial payors continue to categorize SPECT/CT as investigational and not medically necessary for non-hyperparathyroidism indications. The SNMMI stated there is a fundamental lack of understanding among commercial payors' medical review panels regarding the everyday clinical value of SPECT/CT.
The "medical necessity" letter can be personalized by the writer and represents the culmination of work from both SNMMI's coding and reimbursement and government relations committees, as well as its two 2020-2021 Henkin Fellows.
The letter can be downloaded on SNMMI's website.
