Payer Toolkit

“How To” guide for working with payers

Resources on Appropriate Indications and Performance of CMR:

• Guidelines and Clinical Statements

• Guidelines for Performance of CMR
• Clinical Indications
• Standardized Imaging Protocols
• Standardized Post-Processing
• CMR in the AHA/ACC Guidelines
• Cardiac Imaging Appropriate Use Criteria
• CCT and CMR
• Ischemic Heart Disease
• Utilization of Cardiovascular Imaging in Heart Failure
• Multimodality Imaging in Valvular Heart Disease
• Why CMR information on select clinical indications to expedite communications with your payer

Private Payer and Specialty Benefits Manager Coverage Policies:

• Aetna: Magnetic Resonance Imaging of the Cardiovascular System (Updated 2023-08-01)
• Carelon: Imaging of the Heart (Effective 2024-01-01)
• CIGNA and EVICORE: Cardiac Imaging Guidelines (Effective 2024-02-01)
• HealthHelp: Cardiology Services (Effective 2019-03-01)
• Humana:
• Diagnostic and Cardiac Imaging
• Updated policy for Advanced Imaging (Effective 2021-11-01)
• Medical and Pharmacy Coverage Policies – Search Results (humana.com)
• National Imaging Associates (NIA) | Coordinated Care – Cardiac Imaging
• UnitedHealthcare
• Cardiology and Radiology Imaging Guidelines Effective March 20, 2023 – UnitedHealthcare Community Plans (uhcprovider.com)

Having trouble with coverage or pre-authorization?  Please complete and submit this form and the SCMR will do what it can to help.

CMS Resources

• Medicare Administrative Contractor Map (2023-03-28)