A key consideration for physicians engaging in the cost of any diagnostic imaging system is whether or not the amount of procedures and reimbursement is going to justify the expense. The concern comes over the fact that there is a cost prohibitive nature in the machines. From CT scanners, to MRI scanners, to X-Rays, there is a legitimate concern as far as price goes.
Mammography is no different, even if you purchase a system that’s refurbished and in better likely working condition than a newer system. The big concern is what the reimbursement schedule looks like. If your site has been planned properly to house a mammography machine and you have the patients that require it, you still don’t want to force and self refer for an unnecessary procedure, if one has already been performed without abnormality.
The 2012 mammography coverage determined the following:
- Under age 35 no payment is allowed for screening.
- Range 35 to 39 pay one screening mammogram performed on a woman between ages of 35 and 40 and it’s baseline cost.
- Past age 39 it can be performed annually.
These guidelines for payment were laid out by the centers for Medicare and Medicaid services when dealing with Medicare coverage for screening mammography. This particular determination is indicative that it’s important to know and understand your demographic and the demand as far as your demographic is concerned.
It’s vital to not be reckless, patients can’t be forced to undergo difficult procedures unless absolutely necessary. If the procedure is diagnostic as opposed to screening the rules are different. A diagnostic mammogram’s coverage will be covered if the following conditions are met:
- Signs or symptoms of breast disease.
- Personal history of breast cancer.
- A personal history of biopsy proven benign disease.
It’s important to help patients by allowing them the choice to get their procedure done at your facility. It’s still vital to allow your practice and center the ability to justify costs such as electricity and staff as well as proper servicing and maintenance of equipment. It’s also important to explain coverage under insurance to patients. While patients often times are educated on what the insurance covers, it’s good for them to know either way.
Private insurance companies have different guidelines and schedules as far as coverage and reimbursement so it’s going to be different than those who depend on Medicare and Medicaid. While the current legislation known as the affordable care act may make a difference there, currently the rules for coverage are standard.
If you have any questions about refurbished mammography systems please feel free to give us a call. Our team of experts here at Amber Diagnostics is always eager to answer your questions and aid you in the purchase process.
Bobby Serros
President/CEO
407.438.7847
bobbys@amberusa.com
