Radiology Coding Alert

Question: What are the new payment rates that go into effect April 1, 2001, for a screening mammography? I was told that Medicare has authorized additional payment for technologies that convert standard film images to digital form for further analysis. Is this true?

Connecticut Subscriber

Answer: Yes. On Dec. 15, Congress (not HCFA) raised reimbursements for digital mammography and for conversion of standard images to digital form as part of a larger spending bill.

Specifically, the legislation increases Medicare reimbursement for full-field digital diagnostic mammography services to 150 percent of the rate paid for standard diagnostic mammography. Under the new legislation, the average reimbursement for full-field digital mammography will now be about $120. This is significantly higher than payment for standard bilateral diagnostic mammography, which averages about $80. Payment will differ from region to region.

In addition, the bill provides an extra payment of $15 for practices converting standard mammography film to digital images when accompanied by analysis with appropriate software (i.e., computer-aided detection devices).

The American College of Radiology and other professional associations have expressed their disappointment that Congress did not also address payment for standard mammography, which has long been regarded as unfairly low. It noted that standard mammography is more available to most women and is still considered the gold standard of the industry. In addition, digital mammography has not been scientifically proven to be of improved benefit compared with conventional film-screen mammography.