Tomosynthesis Reimbursement

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March 10, 2014:
How will 3D mammography improve outcomes? Scientists debating all forms of detection.

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Tomosynthesis:

Developers of advanced tomography and scanning systems want to make sure that their imaging is more helpful and useful, not only for detection but also for the current process which is considered by some to be uncomfortable and overly clinical.

Does Health Insurance Cover 3-D Mammography (tomosynthesis)?

FDA Approval Allows Fast Track For Health Insurance Coverage

Tomosynthesis reimbursement has recently been made possible by the FDA's approval of the Hologic brand 3D Mammography device. Generally speaking, insurance carriers have to be convinced that tomosynthesis is going to be more reliable or valuable than standard mammograms, or that tomosynthesis allows for early detection which can thereby reduce the average claim cost for breast cancer detection and treatment. For example, if there were evidence that tomosynthesis reduced false positives, which therefore required fewer biopsies, a health insurance carrier would be more likely to approve of tomosynthesis and 3D mammography. Likewise, if a physician can show that tomosynthesis procedures are medically necessary (e.g. in situations involving dense tissue) then there would be an advantage for the patient and health insurance company. In many cases, carriers may approve tomosynthesis imaging but could potentially ascribe higher costs or co-pays if there is not significant evidence of a greater benefit over mammograms. In any case, checking with your health insurance provider is recommended, and your doctor's office may be able to help you find out if your carrier will reimburse you.

The cost of any advanced scanning equipment goes beyond the dollar figure for devices, which are often ordered under leasing arrangements for financial reasons. Hospitals need to consider where the device will be installed, if more construction is needed, or how to balance out the other diagnostic services. Training for operators, imaging techs, and radiologists is critical in order to get good pictures, no matter who eventually ends up looking at them. There is also the question of access for periodic maintenance and upgrades on the devices, sofware fixes, and of course the option to filter the image for the perfect post on Instagram.

Notes and Special Information

Special note: Consult your doctor for more information on reimbursement and whether you could benefit from 3-D Mammography.