CMS Rule Change in 2026 Aims to Expedite Insurance Responses for Medical Scans
In 2026, a new rule by the Centers for Medicare & Medicaid Services (CMS) has been implemented to address the issue of insurance denials for medical scans, such as PET scans. The rule, CMS-0057-F, mandates that insurers must respond to standard prior authorization requests within seven calendar days and urgent requests within 72 hours, a reduction from the previous 14-day period. This change comes in response to widespread frustration among patients, including celebrities like Christy Carlson Romano, who have faced denials for necessary medical scans. Romano, known for her roles in 'Even Stevens' and 'Kim Possible,' shared her experience of having a cancer screening denied by her insurer, highlighting a common issue where insurers deny coverage based on criteria such as lack of prior authorization or medical necessity. The cost of PET scans can range from $1,500 to $6,000, making denials a significant financial burden for patients. 
