DBT Receives Payment Codes From CMS

For months, radiologists have wondered how – and if – the U.S. Centers for Medicare and Medicaid Services would cover digital breast tomosynthesis procedures. Without payment codes, the exams' costs would skyrocket for facilities looking to take advantage of this innovative exam.

AuntMinnie.com reported that CMS has included DBT codes in its final Medicare Physician Fee Schedule and Hospital Outpatient Prospective Payment System, released at the end of October. The development of these codes reflects a positive change for medical imaging specialists who have been at the short end of the stick, being hit with major reimbursement reductions by the federal government.

The national payment rates for DBT will go into effect on Jan. 1, 2015, in the form of two new CPT codes that are add-ons to existing G-codes. These reporting methods will be submitted when DBT is used with either screening or full-field digital mammography. The update will allow for more physicians to adopt the technology, according to Stamatia Destounis, M.D., from Elizabeth Wende Breast Care in Rochester, New York.

"Now facilities may be able to move forward in conversion and implementation of DBT," Destounis told AuntMinnie.com. "DBT has shown in multiple recent clinical studies to reduce recall rates and increase cancer detection – good news for the women we serve. We have been educating our local insurers of the technology and its benefits, so perhaps with these new codes, they will follow CMS' example."

However, CMS wants the Relative Value Scale Update Committee to review all mammography codes, which would have a significant impact on breast imaging procedures. The amount of coverage for different scans could decrease, leading to more out-of-pocket expenses for both doctors and patients.

Tomosynthesis with mammography is cost-effective
According to a recent study published in the online journal Radiology, adding tomosynthesis to biennial mammography screenings can improve breast cancer detection and reduce clinical costs for hospitals.

Breast density has come to the forefront of cancer detection, as the efficacy of mammography is directly impacted by the amount of tissue being scanned. This can lead to lesions being missed due to copious density overlapping malignant growths.

Led by Christoph Lee, M.D., assistant professor in the Departments of Radiology Health Services at the University of Washington, researchers compared the effectiveness and cost of combined mammography with tomosynthesis against traditional mammography alone. They included clinical information from U.S. women ages 50 to 75 years with dense breasts, collecting data from the National Cancer Institute's Breast Cancer Surveillance Consortium, previous medical literature and Medicare reimbursement rates for the procedures.

Using a breast cancer simulation model, Lee and his colleagues developed estimates on supposed costs. Their analysis showed that adding tomosynthesis led to 0.5 fewer deaths and the elimination of roughly 405 false-positive digital imaging reports per 1,000 women after 12 rounds of screenings. The combination of mammography with tomosynthesis remained cost-effective.

"The decrease in false-positive results after adding tomosynthesis is a major contributor to the cost-effectiveness of combined screening," Lee said in a statement. "Our study suggests that adding tomosynthesis at the time of mammography screening has the potential to decrease the number of unnecessary diagnostic work-ups and invasive procedures that result from false-positive findings."

This study is just one of many that underscore the advantages of using DBT in tandem with traditional mammography. It yields more comprehensive results and avoids the complications caused by breast density, which can negatively impact the quality of diagnostic radiology scans. With CMS offering new payment codes for the procedure, it is very possible that more physicians will adopt DBT into their suite of tests to better serve their patients.

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