Highs and Lows of Changing Mammography Dollars

What a roller coaster ride!  Every year, the payment levels for either film or digital mammography have been increased or decreased by 2 to 3%, but now hospital mammography reimbursement is about back where it started a couple of years ago.  The only really significant change has been a 50% decrease in computer-aided detection.  But, as labor and overhead costs increase, how is the industry reacting?

In 2007, a hospital could expect $49 for a screening film mammogram (CPT 76092) and $98 for a digital mammogram (CPT G0202).  Diagnostic digital mammography (CPT G0204, bilateral) was $101, and the add-on for computer-aided detection was $18 (CPT 77051, 77052).  Fast forward to 2010, screening film mammogram was $43 and digital mammogram $94.  Diagnostic digital mammography (G0204) was at $110, and the add-on for computer-aided detection is $8.

I find it interesting that diagnostic digital mammography is the only payment to increase, but it turns out there is a reason why digital technology is reimbursed at a higher rate than film.  Studies have shown that although digital screening costs almost three times as much, it is more effective in detecting breast cancer.

When I spoke to Dr. Steven Harms, MD, director of the Breast Imaging Program at the University of Arkansas Medical Center in Little Rock, Ark., he commented on the advantages of digital mammography and said, “I have reviewed the FDA data on digital mammography and found its detection rate is very useful in identifying breast cancer in its very early stages.  The real advantage of digital X-ray is data storage and telecommunications.  This helps in allowing the process to be quicker and less costly, especially if you want a second opinion to evaluate the image.”

The drive for early detection has made mammography a popular imaging modality in the U.S.  However, a recent study concluded that inappropriately low reimbursement has been a factor in decreased mammography utilization because it puts providers at risks that depend on high volumes.

So how has the industry reacted? I checked with the MD Buyline database and found that sales in mammography systems have dropped 23% in the last two years.  Part of this is due to a tight economy but, on the other hand, capital costs have not dropped significantly.  Let’s see what happens when CMS comes out with the 2011 reimbursement rates.  Hospitals may elect to keep their systems for another year.

James Laskaris, EE, BME
James Laskaris, EE, BME, Clinical Analyst — Mr. James Laskaris is a senior emerging technology analyst at MD Buyline and has been with the company since 1994. With over 30 years of experience in the healthcare field, Mr. Laskaris is the primary analyst of high-end OR technology. He also covers issues related to the legislative and reimbursement effect on healthcare and authors a bimonthly “Issues that Matter” publication. Mr. Laskaris received his biomedical engineering degree from Southern Illinois University. His work has been published in hfm Magazine, Radiology Manager and Healthcare Purchasing News.