In November of 2001, the Centers for Medicare and Medicaid Services (CMS) increased reimbursement rates for mammography procedures included in the Medicare physician fee schedule for calendar year 2002. The codes and amounts associated with this schedule apply to mammography procedures performed in physician offices and freestanding diagnostic imaging centers, and to payment for a physician's professional interpretation of a mammography performed in any setting.

This new code is recognized by all Medicare carriers, intermediaries, most private insurers and HMO's/PPO's to $17.74 (this amount is in addition to the rate for the screening exam itself). Of this total, $14.48 is for technical fees and $3.26 for professional fees. In addition, a HCPCS code was created for the use of CAD with diagnostic mammography, also effective January 1, 2002. It is to be used as an add-on code with the screening mammography code (76092). The new CAD reimbursement amount represents an 18% overall increase over levels established in April 2001, and a 45% increase for the technical portion.

The Medicare fee allowed for this code is a global average of $17.74 when performed in a physician's office and $28.26 when CAD is performed in hospitals.

Last year, private insurers covered 70% of woman 40 and over. Today, that number stands at over 90%. This positive upward trend confirms that private insurers see the importance of CAD mammography in early detection of breast cancer.