The Service Line

UnitedHealthcare will stop asking permission before a child gets a CT, MRI or PET scan, starting December 1. The insurer said November 2 that it is removing prior authorization for more than 2,000 pediatric care codes for members under 18, following through on a May pledge to eliminate nearly two-thirds of its pediatric requirements. AuntMinnie’s reading of the code list shows CT and MRI of the head, spine, chest, abdomen, pelvis and extremities, CT and MR angiography, cardiac MRI and cardiac CT including coronary CT angiography and CT-derived fractional flow reserve, breast MRI and breast CT, and oncologic, brain and cardiac PET and SPECT. Radiation therapy delivery codes, including proton therapy and stereotactic radiosurgery, are on the list too. Prior authorization stays for certain injectables, genetic tests and surgical procedures. For an imaging group, the so-what is staff time and denial exposure: fewer authorization calls and fewer retro-denials on pediatric scans, but only for the commercial, exchange and community plans AuntMinnie says are covered, and only where state law permits. Medicare Advantage is not mentioned, and no adult codes are affected. Confidence: High on the date and the 2,000-code scope per UnitedHealthcare’s own announcement; Medium on the plan types and the line-by-line code list, which we read through AuntMinnie rather than the insurer’s provider bulletin. Sources: Simplifying pediatric care, UnitedHealthcare newsroom, UnitedHealthcare to drop prior authorization for pediatric imaging, AuntMinnie.

Reimbursement

When a Medicare Advantage insurer denies an advanced imaging scan and the case reaches outside review, the denial is overturned about one time in five. A poster at the Society for Imaging Informatics in Medicine meeting in Philadelphia, reported by AuntMinnie October 27, analyzed independent review entity decisions on Medicare Advantage prior authorization denials. Of 9,160 advanced imaging denials (CT, MRI, PET and CT angiography), 20.5 percent were overturned, against 4.1 percent of 378,538 services overall, a risk ratio of 4.98. By modality the rates ran roughly 17 percent for PET to 23 percent for MRI and CT angiography. The authors, from Geisinger Commonwealth School of Medicine, warn these are second-level appeals and therefore a selected sample, not the overall denial rate, and they call for mandatory service-level reporting of Medicare Advantage authorization outcomes. Practically, it argues for appealing every advanced imaging denial that has clinical support. Separately, the CY2027 Medicare physician fee schedule and hospital outpatient final rules had not been published as of today; the July proposals remain the working numbers, and ACR has said it expects the physician fee schedule final in late fall. Confidence: High on the study figures as reported; Medium on what they imply for any one payer, given the selection effect. Sources: Advanced imaging prior authorization denials get overturned, AuntMinnie, Medicare Physician Fee Schedule, American College of Radiology.

Enforcement

We found no new radiology-specific Department of Justice settlement, Office of Inspector General (OIG) report or indictment dated within the window this run. The most recent radiology risk item is The Doctors Company’s radiology malpractice review, released November 3, which names clinical judgment errors, such as misreading studies and delayed test orders, as the most common contributing factor in claims. Its percentages were not published in the summary we could read. Confidence: High that the review exists and its headline finding; no figures to grade.

Source: Radiology malpractice risk review, AuntMinnie.

Who’s Buying

RadNet, the largest publicly traded outpatient imaging chain, is buying its way into the radiologist labor market. On October 26 RadNet agreed to acquire Onrad, a teleradiology and in-hospital radiology staffing company owned by Housatonic Partners, for $350 million in cash and 5 million RadNet shares, plus an earnout of up to $210 million tied to Onrad’s 2027 earnings before interest, taxes, depreciation and amortization (EBITDA). Onrad has more than 130 contracted radiologists supporting more than 225 hospital facilities in 26 states. RadNet expects $190 million to $200 million of first-year revenue and $60 million to $65 million of adjusted EBITDA, and will report Onrad as a third segment, Radiology Professional Services. Close is expected in early 2027, subject to regulatory review. RadNet says pairing Onrad with its DeepHealth AI software can ease the gap between imaging demand and radiologist supply. For independent groups, the buyer that owns your outpatient competition now also sells coverage to your hospital. Also this week, private equity firm Leonard Green acquired imaging equipment service firm Radon, terms not disclosed (single trade report). Confidence: High on the Onrad terms per RadNet’s filing; Low on Radon beyond the fact of the deal. Sources: RadNet announces agreement to acquire Onrad, Form 8-K exhibit, Securities and Exchange Commission, RadNet to acquire teleradiology provider Onrad, AuntMinnie, Leonard Green acquires imaging equipment service firm Radon, AuntMinnie.

Clinical Policy

Pennsylvania has become a licensure state for imaging technologists and radiation therapists. AuntMinnie reported October 29 that Gov. Josh Shapiro signed Senate Bill 1334 as Act 112 of 2026, the Medical Imaging and Radiation Therapy Health and Safety Act, which amends the Medical Practice Act of 1985 and puts licensure of radiography, magnetic resonance imaging, limited practice, radiologist assistant and nuclear medicine technology practitioners under the State Board of Medicine. Technologist societies backed it as a way to hold practitioners to nationally recognized education and certification standards. The article gives no effective date, fee schedule or grandfathering terms, and we could not open the act itself. For multi-state operators, a new licensing board means credentialing lead time and a tighter local labor pool in a profession already short of staff. Confidence: Medium, because enactment and signing date rest on one trade report and earlier coverage showed the bill still moving through the House in the summer. Source: PA enacts licensure law for imaging, radiation therapy professionals, AuntMinnie.

The Operator Metric

The number to track this week: roughly 5.4x to 5.8x, what RadNet is paying for Onrad’s first-year EBITDA on the cash alone. Our arithmetic, not RadNet’s, from its release: $350 million in cash against the expected $60 million to $65 million of adjusted EBITDA gives 5.4x to 5.8x, and adding the full $210 million earnout lifts it to 8.6x to 9.3x. The 5 million RadNet shares are excluded because the release gives no value for them. RadNet says Onrad has grown revenue 10 to 20 percent a year with adjusted EBITDA margins above 30 percent. For a group weighing a sale, the headline is the structure: a cash multiple in the mid-fives with a large contingent piece tied to 2027 results. Confidence: High on the inputs; Medium on comparability, since a staffing platform is not a center portfolio or a hospital contract group. Source: RadNet announces agreement to acquire Onrad, Form 8-K exhibit, Securities and Exchange Commission.