New York State Radiological Society's

Mammography Committee Report

to the Board of Directors

Michael A. Cohen, M.D., F.A.C.R.

April 26, 2003

1. NYSRS Endorsement of State-mandated Increased Reimbursement for Computer Assisted Detection: The NYSRS Mammography Committee met via conference telephone call to reach consensus regarding its position and a recommendation to the Executive Committee on the value of CAD in mammography and the utility of a statelegislated requirement for enhanced third party payer reimbursement for users of CAD. The mammography committee unanimously endorsed the benefits of CAD and supported the concept of legislation to provide enhanced reimbursement for its users. Upon receipt of the Mammography Committee endorsement, the Executive Committee convened via telephone, accepted and approved the Mammography Committee recommendations, and drafted a letter to the New York State Insurance Department detailing the NYSRS position.

2. Effective April 1, 2003 Medicare will cover Computer-Assisted Detection (CAD) performed in conjunction will direct full-field digital mammography. This is an expansion of coverage which formerly included only CAD used in conjunction with film mammograms converted to digital mammograms. Also, CAD can now be used in conjunction with screening and diagnostic mammography, both film and direct digital. Specifically:

· Providers are instructed to use the 2003 CPT descriptor for add-on code "+76085" to describe CAD when used in conjunction with HCPCS Level II code G0202 for direct digital screening mammography when CAD is used (even though this add-on code specifies "digitization of film radiographic images"). It will be appropriate to submit code +76085 with screening mammography codes 76092 (screening mammography) and G0202 (direct digital screening mammography) when CAD is performed. The ACR has asked the CPT Editorial Panel to change the descriptor for +76085 so that it will appropriately describe the use of CAD with either "film-to-digital" or "full-field digital" mammography to lessen confusion.

· Also, the 2003 HCPCS descriptor for CAD (+G0236) has been revised to include the phrase "or computer analysis of digital mammogram for lesion detection". It will be appropriate to use code +G0236 to describe CAD when performed in conjunction with diagnostic mammography codes 76091 (bilateral diagnostic mammogram), 76090 (unilateral diagnostic mammogram), G0204 (bilateral diagnostic direct digital imaging), and G0206 (unilateral diagnostic direct digital imaging)

3. As of Feb. 15, 2003, the ACR will be the accrediting body for General Electric Senographe 2000D full-field digital mammography units. All GE FFDM units currently approved by the FDA, as well as newly installed units, will be required to submit application for accreditation to the ACR. Additional information and forms can be obtained on the ACR Web site.

4. "Assure Access to Mammography Act of 2003" Bills Both the House (H.R. 817 sponsored by Representatives Peter King (R-NY) and David Hobson (R-Ohio) and Senate (S. 869 sponsored by Tom Harkin (D-Iowa) and Olympia Snowe (R-Maine) are considering identical bills which seek to reduce lengthy waiting times for mammograms by increasing Medicare reimbursement and hopefully stemming the tide of mammography facility closures and service cut-backs. The bills seek to close the reimbursement/cost disparity that exists in hospitals by doubling the Medicare Physician Fee Schedule technical portion for screening and diagnostic mammograms performed in a hospital. Additionally, the bill also provides for additional radiology residency slots by allowing residency programs to add one resident every five years.

5. As of April 18, 2003, Medicare carriers must implement reimbursement for percutaneous image-guided breast biopsy of non-palpable and palpable breast lesions in their claims processing unit. Medicare payment for ultrasound and stereotaxic guidance, when used to biopsy palpable lesions, will be retroactive for procedures done on or after Jan.1, 2003. However, it should be noted that individual carriers still have the discretion to decide specifically what types of palpable lesions they will reimburse. The ACR Carrier Advisory Committee representatives will now begin work to educate carrier medical directors on the appropriate use and indications for image-guided biopsy of palpable lesions. Medicare coverage now includes image-guided biopsies of the following breast lesions:

Coverage for imaging used to guide biopsy of difficult palpable lesions. The specific lesions covered in this category are at the discretion of individual carriers and have yet to be fully determined.

NYSRS Website Host:
Department of Radiology
School of Medicine
State University of New York at Stony Brook
Health Sciences Center