Missouri gets tomosynthesis coverage

by Thomas Dworetzky, Contributing Reporter | June 14, 2018
A flurry of bill-signing ahead of Missouri Governor Eric Greitens' May 29 resignation saw some good news for healthcare providers and their patients.

The Governor signed HB 1252, which means healthcare insurers have to provide benefits or coverage for low-dose mammography screening – it also expands the definition of now-mandated breast tomosynthesis.

The term “low-dose mammography screening” was revised, the ACR reported in its statement.

“As used in this section, the term 'low-dose mammography screening' shall also include digital mammography and breast tomosynthesis,” says HB 1252, which continues, “As used in this section, the term 'breast tomosynthesis' shall mean a radiologic procedure that involves the acquisition of projection images over the stationary breast to produce cross-sectional digital three-dimensional images of the breast.”

Additionally, the law sets the date of January 1, 2019, as the moment from which low-dose mammography screening “shall be reimbursed at rates accurately reflecting the resource costs specific to each modality, including any increased resource cost of breast tomosynthesis.”

In March, mammograms were in the news when new evidence was announced that supports starting breast-screening at age 40.

“We showed the data of our screening population of 50 and over (as USPSTF recommends screening age 50 and over) and then showed how the data changes when we add the screening population 40-49 to the previous group (as ACR and SBI recommend screening at age 40),” Dr. Abid Irshad of the Medical University of South Carolina, told HCB News.

Irshad's team evaluated over 41,000 screening mammography exams.

Across all age groups, there were 5,196 callbacks, 1,164 biopsies and 326 cancers detected. Women age 40-49 account for 8,913 mammograms, and had 1,518 callbacks and 306 biopsies, while 52 cancers were detected.

“What we found was that by including the screening data of the age group 40-49 to the screening data of 50 and above, 19.3 percent additional cancers were found at the expense of an overall 1.5 percent increased callbacks and 0.1 percent increased biopsies,” said Irshad.

The outgoing Missouri governor also signed SB 982, which lays out payment for "unanticipated out-of-network (OON) care."

These have been in the news nationally, especially in cases when a patient at an in-network facility gets treated by an an out-of-network provider – and gets hit with a big bill.

SB 982, noted the ACR, will force insurers to cover the out-of-network provider whose services are “necessary to screen and stabilize a patient. ... [Reimbursements] shall be paid directly to the health care provider and within 180 days of providing unanticipated OON care.”

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