The following is a summary of “Is There Utility to Requiring Spine MRI Pre-authorizations?,” published in the June 2023 issue of Spinal Disorders and Techniques by Kebaish et al.

The study design used was a retrospective cohort study of a patient receiving treatment at the Spine Center of a singular institution. This study examined the rates and ultimate disposition of preauthorizations required before ordering spine MRIs from an academic spine center. Spine magnetic resonance imaging (MRI) frequently requires prior authorization from insurance companies. Despite the potential benefits of assuring consistent imaging modalities indicators, previous research has shown that such processes can add administrative burdens and barriers to care. 

Patients from the spine center of a single academic institution covered by commercial insurance and ordered a spine MRI were identified between January 2013 and December 2019. Each of these studies’ prerequisites for preauthorization and eventual disposition were monitored. Multivariate logistic regression determined whether commercial insurance carriers or anatomic region MRIs were associated with preauthorization requirements. The ultimate nature of studies related to this process was monitored. In total, 2,480 MRI requests were identified, of which 2,122 (or 85.56%) required preauthorization. Preauthorization was more likely to be needed for thoracic (OR=2.71, P=0.003) and lumbar (OR=2.46, P<0.001) scans than for cervical scans. Four of the five commercial carriers had statistically significant increased odds of requiring preauthorization relative to a reference insurer (OR=1.54–10.17, P<0.050 for each). 

The peer-to-peer review was required for 204 (9.61%) imaging studies requiring preauthorization, and 1,747 (82.33% of all imaging studies requiring preauthorization) were approved. 275 (77.33%) of the 375 (17.67%) initial cancellations or denials caused by the preauthorization process were completed within three months. Only 85 projects were not ultimately approved and implemented. About 85.56% of 2,480 distinct MRI orders required prior authorization from commercial insurers. However, 96.57% of all scans were completed within three months, which raises concerns about the costs, benefits, and overall value of this administrative process.

Source: journals.lww.com/jspinaldisorders/Abstract/2023/06000/Is_There_Utility_to_Requiring_Spine_MRI.2.aspx