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Breast MR for cancer survivors may result in unnecessary biopsies No difference in sensitivity compared to mammography alone

One-third of breast cancer patients not aware of minimal scarring surgery Remote incisions can avert physical and psychological impacts of scarring

American Society of Breast Surgeons proposes new screening guidelines ACR voices support for new approach, which is based on individual patient risk

Q&A with Danilo Gennari Discussing what DeHCA Light & Sound brings to breast cancer diagnoses

Latest ACP mammo guidelines elicit strong opposition Experts say findings could lead to 10,000 more breast cancer deaths annually

Study supports 3D mammography for older women, contrary to USPTSF recommendation New data sheds light on risk-benefit ratio of screening older patients

FDA proposes changes to mammography regulations First agency efforts to 'modernize' breast screening in over two decades

Volpara and GE expand breast density software partnership GE will become global distributor of VolparaDensity software

Not all breast density laws are created equally Research shows that the wording of some notifications result in supplemental testing, others don't

3D mammography helps avoid unnecessary breast biopsies, says study 33 percent difference in biopsy rate compared to standard mammography

CPT code for 3-D mammo may lead to more adoption

by Lauren Dubinsky , Senior Reporter
Last Friday CMS established national average payment rates for the category I current procedural terminology (CPT) code for 3-D screening mammography and also created a new add-on health care common procedure coding system (HCPCS) code for 3-D diagnostic mammography.

The CPT code for 3-D screening mammography assigned a payment rate of about $57, which is an add-on to the current 2-D mammography code with a $135 payment rate. For unilateral or bilateral images, the 3-D diagnostic mammography code also assigned a payment rate of about $57, which is an add-on to the 2-D mammography unilateral code with a $130 payment rate and the bilateral code with a $165 payment.

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"The availability of reimbursement for 3D mammography is yet another validation of the importance of this game-changing technology in the screening and detection of breast cancer," Peter J. Valenti III, division president of breast and skeletal health solutions at Hologic, Inc., said in a statement.

Leerink Partners, an investment bank that specializes in health care, believes that the $57 will be "met with enthusiasm by the breast imaging community," since it's above the $20 to $50 range. Furthermore, they think it will incentivize more "economically sensitive" radiologists and centers to adopt the technology.

Leerink also believes that it may lead to both Medicare and private payors coverage decisions. They did admit that the establishment of CPT codes is not a guarantee of reimbursement but since the ACR has been diligently pushing for it they think it's just a matter of time before private payors start to cover it.

They predict that ACR and companies including Hologic and GE Healthcare will increase lobbying efforts with individual payors in the near future. Additionally, they speculate that the upcoming RSNA conference at the end of the month will raise awareness about the clinical data and reimbursement progress of the technology.

The CMS Medicare Physician Fee Schedule proposed rule that was released in July suggested that the mammography G-code should be re-valued since it could be potentially misvalued. Leerink thinks that it will be put on hold until CMS believes that they are "better equipped" to make that sort of evaluation.

They also predict that CMS will eventually combine 2-D digital mammography G-codes, plain film CPT codes and the new 3-D mammography CPT code into one code. But they stated that it is not clear when it will happen and what the payment implications will be.

The new codes for 3-D mammography will go into effect on January 1, 2015.

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