Potential Loss of Breast Needle Biopsy Access Due to CPT Code Changes

As many American College of Radiology (ACR) members are aware, the 2014 Current Procedural Terminology (CPT) codes include six breast biopsy codes that have resulted in decreases in relative value units (RVUs) and reimbursement for image-guided percutaneous breast core needle biopsies. The ACR estimates this will result in a 38 percent reduction in professional component and 7 percent reduction in global payment for the breast biopsy codes.

Review of information from the ACR breast ultrasound and stereotactic core needle biopsy accreditation programs provides some insight into availability of breast biopsy services. Currently, 1,982 facilities are accredited to perform breast ultrasound and 1,303 facilities are accredited to perform stereotactic core needle biopsy. The pace of initial applications has slowed (207 in 2013, 303 in 2012 and 336 in 2011 for ultrasound and 211 in 2013, 246 in 2012 and 244 in 2011 for stereotactic) while the total number of facilities seeking initial and renewal accreditation is stable (709 in 2013, 673 in 2012 and 676 in 2011 for ultrasound and 524 in 2013, 536 in 2012 and 436 in 2011 for stereotactic). This data suggests that, even before the recent reduction in reimbursement, the number of facilities performing breast biopsies was not increasing.

This decrease in reimbursement could certainly discourage practices from starting or expanding breast biopsy services. It may even prove financially difficult for some facilities to continue to perform these procedures. As the population ages, we may find that access for breast biopsies is declining just as the demand for these procedures is on the rise.

Author – Dana H. Smetherman, M.D., MPH, FACR

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