The Path to Breast Tomosynthesis Coverage

Recently we’ve heard that ACR members have been contacted by industry representatives requesting them to urge the College to support Medicare coverage of breast tomosynthesis. A detailed update of what’s been happening at the College on this issue is on the ACR website.

As radiologists, we are committed to ensuring that our patients have access to life-saving screening for breast cancer, and yet we are also tasked with critically evaluating emerging technology so we can add new modalities and techniques in a responsible way. The ability of tomosynthesis to reduce recall rates and improve cancer detection carries great promise, but further studies are needed to assess its relationship to long-term clinical outcomes, including reduced mortality.

With the spotlight more than ever before on value, it will also be important to learn which subgroups of women might benefit most from these exams (by age, breast density, frequency of examination, etc.).

That said, if we want to understand the effect that tomosynthesis has on outcomes and who will benefit most, the technology must be widely available. We know that availability will be greatly impacted by whether or not the service is reimbursed, so we are urging CMS to cover Medicare beneficiaries for tomosynthesis when it is performed.

We’ve already worked within the payment policy process to develop CPT codes for tomosynthesis and we’ll hear Medicare’s decision on whether they will cover it — and if so at what rate — when the Final Medicare Rule for 2015 is published in or around late October.

Geraldine B. McGinty, MD, MBA, FACR

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