Position Statement

Neurosurgery Issues Position Statement on Prior Auth Imaging Requirements

  • AANS/CNS Washington Office

Position Statement on Image Sharing Requirement for Prior Authorization

Prior authorization is an administrative process requiring physicians to obtain pre-approval for medical treatments or tests before rendering this care to their patients. Obtaining this approval from payers is burdensome and costly to physician practices. It requires providers and their staff to spend considerable time communicating with payers, thus taking away from time spent in actual patient care. This administrative process is often required even for treatments and tests that are eventually routinely approved.1,2,3,4 As a result, needed care may be denied or delayed.

Commercial health plans and other third-party payers are now considering incorporating real-time image sharing as a prior authorization requirement for spinal surgery. The decision for surgical intervention for spinal disorders requires a comprehensive patient history, physical examination and review of imaging studies. All three are necessary components of the decision-making process. Imaging on its own should never be the basis for instituting treatment. A tenet of surgical treatment is never to treat the radiograph but always treat the patient and their symptoms.

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