Hi RBMA, Happy New Year
I wanted to bring to everyone's attention, here in MA, we are beginning to see the commercial payers; i.e., BCBS and Harvard Pilgrim Healthcare/Tufts starting to reduce their tomosynthesis reimbursement by:
- Paying DX Mammo OR DX Tomosynthesis; not both. This is without any increase in mammogram or tomosynthesis payment. It isn't consistent between payers. BCBS will pay the DX Mammo, but not the DX Tomosynthesis. HPHC/Tufts will pay the DX tomo, but not the DX Mammo when performed on the same day.
- BCBSMA, as of 4/1/20, will be reducing the Screening Tomosynthesis by 50% for both the TC and 26 when billed with a screening mammogram!
- HPHC does not pay for screening tomosynthesis in MA, but does in CT because it is mandated by legislation. Tufts pays for both screening Mammo and Tomo
Our local Mass Radiological Society is working on this from a legislative approach. However, I would be interested in knowing if any of the RBMA membership are starting to see this in your state. What usually starts here in MA, usually makes its way through the country.
Christie James, MS, FRBMA
Sr. Manager, Radiology Revenue Cycle Optimization
Group Practice Management, Massachusetts General Physicians Organization
Immediate Past President, RBMA Board of Directors
62 13th Street | Charlestown, MA 02129
Cell Phone: (802) 291-5308 |Office Phone: (617) 724.4106 | Fax: (617) 643-7941 | Email:cdjames@partners.org
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