Global BulletinAll NewsFDA Approval AlertWomen in Oncology
Around the PracticeBetween the LinesFace OffFrom All AnglesMeeting of the MindsOncViewPodcastsTraining AcademyTreatment Algorithms with the Oncology BrothersVideos
Conferences
All JournalsEditorial BoardFor AuthorsYear in Review
Frontline ForumSatellite Sessions
CME/CE
Awareness MonthNurse Practitioners/Physician's AssistantsPartnersSponsoredSponsored Media
Career CenterSubscribe
Adverse Effects
Brain Cancer
Breast CancerBreast CancerBreast Cancer
Gastrointestinal CancerGastrointestinal CancerGastrointestinal CancerGastrointestinal CancerGastrointestinal CancerGastrointestinal Cancer
Genitourinary CancersGenitourinary CancersGenitourinary CancersGenitourinary Cancers
Gynecologic CancersGynecologic CancersGynecologic CancersGynecologic Cancers
Head & Neck Cancer
Hematologic OncologyHematologic OncologyHematologic OncologyHematologic Oncology
InfectionInfection
Leukemia
Lung CancerLung CancerLung Cancer
Lymphoma
Neuroendocrine Tumors
Oncology
Pediatric Cancers
Radiation Oncology
Sarcoma
Screening
Skin Cancer & Melanoma
Surgery
Thyroid Cancer
Spotlight -
  • Radiation Oncology
  • Surgery
Adverse Effects
Brain Cancer
Breast CancerBreast CancerBreast Cancer
Gastrointestinal CancerGastrointestinal CancerGastrointestinal CancerGastrointestinal CancerGastrointestinal CancerGastrointestinal Cancer
Genitourinary CancersGenitourinary CancersGenitourinary CancersGenitourinary Cancers
Gynecologic CancersGynecologic CancersGynecologic CancersGynecologic Cancers
Head & Neck Cancer
Hematologic OncologyHematologic OncologyHematologic OncologyHematologic Oncology
InfectionInfection
Leukemia
Lung CancerLung CancerLung Cancer
Lymphoma
Neuroendocrine Tumors
Oncology
Pediatric Cancers
Radiation Oncology
Sarcoma
Screening
Skin Cancer & Melanoma
Surgery
Thyroid Cancer
    • Conferences
    • CME/CE
    • Career Center
    • Subscribe
Advertisement

23 Trends in Screening and Diagnostic Mammogram Reimbursement From 2002 to 2022

April 26, 2023
By Alexander L. Hsu
Cheng-Han Lee
  • Naveen Galla
  • Julian Franko
  • Karanveer Purewal

Publication
Article
Miami Breast Cancer Conference® Abstracts Supplement40th Annual Miami Breast Cancer Conference® - Abstracts
Volume 37
Issue suppl 4
Pages: 42-43

Background

In the United States, the Centers for Medicare and Medicaid Services (CMS) effectively determines the amount reimbursed for examinations and procedures. Health care reimbursement plays an important role in the operations of diagnostic radiology. Understanding reimbursement mechanisms, particularly in breast imaging, and its trends in context with other radiological examinations can offer insight into the fundamental operations and future of breast imaging.

Materials and Methods

CMS reimbursement amounts for screening bilateral mammograms and diagnostic bilateral mammograms were acquired by inputting their associated CPT codes into the CMS physician fee schedule database. Technical component reimbursement, professional component reimbursement, and total reimbursement for each exam were recorded for every other year from 2002 to 2022. The same process was additionally applied for 3 other common radiological exam types outside of breast imaging: one-view chest radiograph, computed tomography (CT) of the head without contrast, and CT of the abdomen and pelvis without contrast. The data were recorded, and linear regression analysis was performed using Microsoft Excel.

Results

A total of 11 reimbursement data point sets were acquired from 2002 to 2022. Six data point sets could be acquired for the CT abdomen and pelvis without contrast exam from 2012 to 2022. The correlation coefficients for total reimbursements for screening bilateral mammograms was –1.5, diagnostic bilateral mammogram was 3.1, chest radiograph 1-view was –0.8, CT head without contrast was –25.1, and CT abdomen and pelvis without contrast was –8.3.

Conclusions

In the 20-year study period, radiological examinations in general demonstrated decreasing reimbursement over time. However, mammograms appear to be less affected by this negative trend with screening and diagnostic bilateral mammogram reimbursement, exhibiting relative stability compared with CT examinations of the head as well as abdomen and pelvis. In fact, diagnostic bilateral mammogram reimbursement was the only examination that demonstrated a positive correlation coefficient and an increase in reimbursement over the 20-year period. This stability in reimbursement portends a positive outlook for breast imaging and reinforces the role of this crucial imaging from a public health perspective.

AFFILIATIONS:

Alexander L. Hsu,1 Cheng-Han Lee,1 Naveen Galla,1 Julian Franko,1 Karanveer Purewal2

1Department of Radiology, Icahn School of Medicine at Mount Sinai (West), New York, NY.

2Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD.

Download Issue PDFDownload PDF
Articles in this issue

1 Elacestrant Versus Fulvestrant or Aromatase Inhibitor in a Phase 3 Trial Evaluating Elacestrant, an Oral Selective Estrogen Receptor Degrader Versus Standard-of- Care Endocrine Monotherapy for ER+/HER2– Advanced/Metastatic Breast Cancer
1 Elacestrant Versus Fulvestrant or Aromatase Inhibitor in a Phase 3 Trial Evaluating Elacestrant, an Oral Selective Estrogen Receptor Degrader Versus Standard-of- Care Endocrine Monotherapy for ER+/HER2– Advanced/Metastatic Breast Cancer
2 Molecular Characterization of HER2-Low Patients Identifies Basal-Enriched Subset With Poor Clinical Outcomes in Real-world Data
2 Molecular Characterization of HER2-Low Patients Identifies Basal-Enriched Subset With Poor Clinical Outcomes in Real-world Data
3 Real-world Outcomes of Sacituzumab Govitecan in Metastatic Breast Cancer Patients: A Single Institution Experience
3 Real-world Outcomes of Sacituzumab Govitecan in Metastatic Breast Cancer Patients: A Single Institution Experience
4 Datopotamab Deruxtecan (Dato-DXd) + Durvalumab (D) as First-Line (1L) Treatment for Unresectable Locally Advanced/ Metastatic Triple-Negative Breast Cancer (a/mTNBC): Updated Results From BEGONIA, a Phase 1b/2 Study
4 Datopotamab Deruxtecan (Dato-DXd) + Durvalumab (D) as First-Line (1L) Treatment for Unresectable Locally Advanced/ Metastatic Triple-Negative Breast Cancer (a/mTNBC): Updated Results From BEGONIA, a Phase 1b/2 Study
5 Treatment Patterns and Clinical Outcomes in Patients Receiving Palbociclib Combinations as First- Line Treatment for Advanced or Metastatic Breast Cancer in Realworld Settings in Argentina and Colombia: Results from the IRIS Study
5 Treatment Patterns and Clinical Outcomes in Patients Receiving Palbociclib Combinations as First- Line Treatment for Advanced or Metastatic Breast Cancer in Realworld Settings in Argentina and Colombia: Results from the IRIS Study
7 EMERALD Phase 3 Trial of Elacestrant Versus Standard-of- Care Endocrine Therapy in Patients With ER+/HER2– Metastatic Breast Cancer: Updated Results by Duration of Prior CDK4/6i in Metastatic Setting
7 EMERALD Phase 3 Trial of Elacestrant Versus Standard-of- Care Endocrine Therapy in Patients With ER+/HER2– Metastatic Breast Cancer: Updated Results by Duration of Prior CDK4/6i in Metastatic Setting
8 Datopotamab Deruxtecan (Dato-DXd) in Advanced Triple- Negative Breast Cancer (TNBC): Updated Results From the Phase 1 TROPION-PanTumor01 Study
8 Datopotamab Deruxtecan (Dato-DXd) in Advanced Triple- Negative Breast Cancer (TNBC): Updated Results From the Phase 1 TROPION-PanTumor01 Study
9 Phase 1 TROPION-PanTumor01 Study Evaluating Datopotamab Deruxtecan (Dato-DXd) in Unresectable or Metastatic Hormone Receptor–Positive/ Human Epidermal Growth Factor Receptor 2–Negative Breast Cancer
9 Phase 1 TROPION-PanTumor01 Study Evaluating Datopotamab Deruxtecan (Dato-DXd) in Unresectable or Metastatic Hormone Receptor–Positive/ Human Epidermal Growth Factor Receptor 2–Negative Breast Cancer
11 Real-world Treatment Patterns and Effectiveness of Palbociclib Plus an Aromatase Inhibitor in Patients With Metastatic Breast Cancer Aged 75 Years or Above
11 Real-world Treatment Patterns and Effectiveness of Palbociclib Plus an Aromatase Inhibitor in Patients With Metastatic Breast Cancer Aged 75 Years or Above
12 TIP HARMONIA SOLTI-2101/ AFT-58: A Head-to-Head Phase III Study Comparing Ribociclib (RIB) and Palbociclib (PAL) in Patients (pts) With Hormone Receptor– Positive/HER2-Negative/HER2- Enriched (HR+/HER2−/HER2-E) Advanced Breast Cancer (ABC)
12 TIP HARMONIA SOLTI-2101/ AFT-58: A Head-to-Head Phase III Study Comparing Ribociclib (RIB) and Palbociclib (PAL) in Patients (pts) With Hormone Receptor– Positive/HER2-Negative/HER2- Enriched (HR+/HER2−/HER2-E) Advanced Breast Cancer (ABC)
13 Improved Sensitivity in Identification of ER- and HER2- Expressing Metastatic Breast Cancers With a Combination of Cell & Cell-Free Liquid Biopsy Analysis
13 Improved Sensitivity in Identification of ER- and HER2- Expressing Metastatic Breast Cancers With a Combination of Cell & Cell-Free Liquid Biopsy Analysis
15 Updated Expert Consensus Recommendations for Managing Hyperglycemia and Rash in Patients With PIK3CA-Mutated, Hormone Receptor–Positive (HR+), Human Epidermal Growth Factor Receptor 2–Negative (HER2–) Advanced Breast Cancer Treated With Alpelisib
15 Updated Expert Consensus Recommendations for Managing Hyperglycemia and Rash in Patients With PIK3CA-Mutated, Hormone Receptor–Positive (HR+), Human Epidermal Growth Factor Receptor 2–Negative (HER2–) Advanced Breast Cancer Treated With Alpelisib
16 Primary Results From the Randomized Phase II RIGHT Choice Trial of Premenopausal Patients With Aggressive HR+/HER2− Advanced Breast Cancer Treated With Ribociclib + Endocrine Therapy vs Physician’s Choice Combination Chemotherapy
16 Primary Results From the Randomized Phase II RIGHT Choice Trial of Premenopausal Patients With Aggressive HR+/HER2− Advanced Breast Cancer Treated With Ribociclib + Endocrine Therapy vs Physician’s Choice Combination Chemotherapy
17 A Clinical Systematic Literature Review of Treatments Among Patients With Advanced/ Metastatic HER2+ Breast Cancer
17 A Clinical Systematic Literature Review of Treatments Among Patients With Advanced/ Metastatic HER2+ Breast Cancer
20 TIP ELONA: An Open-Label, Phase 1b-2 Study of Elacestrant, in Combination With Onapristone in Patients With Estrogen Receptor– Positive, Progesterone Receptor– Positive, HER2-Negative Advanced or Metastatic Breast Cancer
20 TIP ELONA: An Open-Label, Phase 1b-2 Study of Elacestrant, in Combination With Onapristone in Patients With Estrogen Receptor– Positive, Progesterone Receptor– Positive, HER2-Negative Advanced or Metastatic Breast Cancer
Related Content
Advertisement

The Lived Experience of Talquetamab Therapy in a Patient With Multiple Myeloma

The Lived Experience of Talquetamab Therapy in a Patient With Multiple Myeloma

ONCOLOGY Staff
September 27th 2025
Article

Karen Kehl shares her decade-long journey with multiple myeloma, discussing treatment options and the impact of bispecific antibodies like talquetamab with Binod Dhakal, MD.


Multidisciplinary Team Discusses Practical Treatment Options in NSCLC

Multidisciplinary Team Discusses Practical Treatment Options in NSCLC

ONCOLOGY Staff
September 26th 2025
Article

Experts at City of Hope explore innovative immunotherapy strategies for non-small cell lung cancer, highlighting efficacy and toxicity management in treatment.


Boston’s Best Did Not “Leave the Cannoli” in Battle of Lymphoma Top Trials

Boston’s Best Did Not “Leave the Cannoli” in Battle of Lymphoma Top Trials

ONCOLOGY Staff
September 25th 2025
Article

Two teams of lymphoma experts engage in a face-off competition, showcasing real-world updates, patient cases, and use of ASCT or CAR T-cell therapy.


Employing Comprehensive Genomic Testing in the NSCLC Paradigm

Employing Comprehensive Genomic Testing in the NSCLC Paradigm

ONCOLOGY Staff
September 24th 2025
Article

An expert discusses the vital role of comprehensive genomic profiling in personalizing treatment for non-small cell lung cancer, enhancing patient outcomes.


3 Things You Should Know About TROP2 as a Therapeutic Target in Triple-Negative Breast Cancer

3 Things You Should Know About TROP2 as a Therapeutic Target in Triple-Negative Breast Cancer

ONCOLOGY Staff
September 23rd 2025
Article

Read an expert-led article on the latest advancements in TROP2-targeted antibody-drug conjugates for treating triple-negative breast cancer and improving patient outcomes.


3 Things You Should Know About Data Presented at ESMO GI

3 Things You Should Know About Data Presented at ESMO GI

ONCOLOGY Staff
September 22nd 2025
Article

New therapies for hepatobiliary cancers show promise, expanding treatment options for patients with advanced disease and challenging conditions.

Related Content
Advertisement

The Lived Experience of Talquetamab Therapy in a Patient With Multiple Myeloma

The Lived Experience of Talquetamab Therapy in a Patient With Multiple Myeloma

ONCOLOGY Staff
September 27th 2025
Article

Karen Kehl shares her decade-long journey with multiple myeloma, discussing treatment options and the impact of bispecific antibodies like talquetamab with Binod Dhakal, MD.


Multidisciplinary Team Discusses Practical Treatment Options in NSCLC

Multidisciplinary Team Discusses Practical Treatment Options in NSCLC

ONCOLOGY Staff
September 26th 2025
Article

Experts at City of Hope explore innovative immunotherapy strategies for non-small cell lung cancer, highlighting efficacy and toxicity management in treatment.


Boston’s Best Did Not “Leave the Cannoli” in Battle of Lymphoma Top Trials

Boston’s Best Did Not “Leave the Cannoli” in Battle of Lymphoma Top Trials

ONCOLOGY Staff
September 25th 2025
Article

Two teams of lymphoma experts engage in a face-off competition, showcasing real-world updates, patient cases, and use of ASCT or CAR T-cell therapy.


Employing Comprehensive Genomic Testing in the NSCLC Paradigm

Employing Comprehensive Genomic Testing in the NSCLC Paradigm

ONCOLOGY Staff
September 24th 2025
Article

An expert discusses the vital role of comprehensive genomic profiling in personalizing treatment for non-small cell lung cancer, enhancing patient outcomes.


3 Things You Should Know About TROP2 as a Therapeutic Target in Triple-Negative Breast Cancer

3 Things You Should Know About TROP2 as a Therapeutic Target in Triple-Negative Breast Cancer

ONCOLOGY Staff
September 23rd 2025
Article

Read an expert-led article on the latest advancements in TROP2-targeted antibody-drug conjugates for treating triple-negative breast cancer and improving patient outcomes.


3 Things You Should Know About Data Presented at ESMO GI

3 Things You Should Know About Data Presented at ESMO GI

ONCOLOGY Staff
September 22nd 2025
Article

New therapies for hepatobiliary cancers show promise, expanding treatment options for patients with advanced disease and challenging conditions.

Advertisement
About
Advertise
CureToday.com
OncLive.com
OncNursingNews.com
TargetedOnc.com
Editorial
Contact
Terms and Conditions
Privacy
Do Not Sell My Personal Information
Contact Info

2 Commerce Drive
Cranbury, NJ 08512

609-716-7777

© 2025 MJH Life Sciences

All rights reserved.