Reimbursement breast cancer mri

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Breast magnetic resonance imaging MRI is a sensitive method of breast imaging virtually uninfluenced by breast density. Because of the improved sensitivity, breast MRI is increasingly being used for detection of breast cancer among high risk young women. However, the specificity of breast MRI is variable and costs are high.

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Breast MRI has become an accepted screening tool for high-risk women, especially since the American Cancer Society ACS gave the technology a vote of confidence in by adding it to its breast cancer screening guidelines. But many payors appear to be dragging their feet when it comes to paying for breast MRI exams. Reimbursement for breast MRI screening varies by insurance provider, individual insurance policy, geographic location, and not infrequently, the lack of understanding of the diagnostic value of the procedure by an employee of a third-party radiology benefits management company.

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Mean SD and median paid amounts for breast diagnostic procedures, all patients and by payer, in US dollars. Little data exist on real-world patterns and associated costs of downstream breast diagnostic procedures following an abnormal screening mammography or clinical exam. To analyze the utilization patterns in real-world clinical settings for breast imaging and diagnostic procedures, including the frequency and volume of patients and procedures, procedure sequencing, and associated health care expenditures.

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In stark contrast, breast MRI, has made little impact to the commercial MRI market, despite potentially holding the greatest potential and clinical value. Clinical evidence supporting the use of MRI for breast imaging is growing in volume and credibility, such as the recent findings that a follow-up MRM scan for patients with equivocal findings from conventional mammography offered "absolute certainty" for tumor detection. While further evidence and larger trials are required, such evidence suggests MRI has a significant role to play in breast imaging in the future. The first and most complex barrier to adoption is the varying degree to which breast MRI is regulated and reimbursed across Europe.

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In breast imaging practice we seek to provide care that is compas-sionate, patient-centered and evidence-based. The top aims are always to save lives and minimize the impact of breast cancer. As is true across U.

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Breast MRI is a technique that uses a magnetic field to create an image of the breast tissue, using hundreds of images taken very quickly. It does not use radiation or X-rays like a mammogram does. Breast MRI usually involves an injection into a vein in the arm.

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Of particular concern is the number of false-positive findings and breast biopsies that are ultimately found to be noncancerous. This issue is the catalyst for an ongoing study at the University of Pittsburgh Medical Center, where researchers are looking to bring more specificity to the screening process with contrast-enhanced mammography, an application that uses iodine contrast agent in conjunction with mammography. Contrast-enhanced mammography has been shown to improve the determination of malignancy probability and BI-RADS assessment when compared with conventional mammography alone.

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Aetna considers breast MRI a medically necessary adjunct to mammography for screening of women considered to be at high genetic risk of breast cancer because of any of the following:. Aetna considers breast MRI medically necessary to detect intra-capsular silent rupture of silicone gel-filled breast implants. Mammography is the only screening test proven to lower breast cancer morbidity and mortality.

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Breast MRI is used in breast cancer screening for women at higher than average risk. Screening with mammography plus breast MRI is not recommended for women at average risk of breast cancer. Compared to mammography, screening with breast MRI has some drawbacks [ ]:.

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For many practices today, barriers to payment are sometimes merely a lack of accurate billing tools. When practices do not have access to appropriate coding and coverage guidelines, they don't have the correct tools to report procedures, resulting in reimbursement issues. Please use the links below to find out more:. Contrast agents also continue to be bundled in

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