Reimbursement for contrast-enhanced mammography is on the rise
Despite contrast-enhanced mammography (CEM) not being as widely implemented as other breast cancer detection strategies, many hospitals have been able to secure reimbursement for the modality.
CEM was introduced commercially in 2011, but many providers were initially hesitant to embrace the technology. Since then, numerous studies have detailed its sensitivity for breast cancer detection and experts have lent their support for its routine use in screening settings.
Despite this, CEM remains underutilized. Experts suggest that reimbursement, or lack thereof, could be preventing CEM from being more widely implemented.
“The potential of CEM to serve as a realistic cost-effective alternative to breast MRI has been described. Nevertheless, the principal economic barrier to its adoption is the absence of specific reimbursement for CEM in many healthcare systems,” Thiemo J.A. van Nijnatten, MD, with the department of radiology and nuclear medicine at Maastricht University Medical Center, in the Netherlands, and colleagues wrote in the European Journal of Radiology. “To overcome this issue, various strategies have been implemented.”
The group recently conducted an analysis that included data on reimbursement for CEM from hospitals across the globe. In total, 29 breast radiologists answered a questionnaire related to their organization’s use of CEM and whether they receive insurance payment for the service.
Every respondent indicated their organization implemented CEM at some point between 2011 and 2024. All but two of the institutions reported charging less for CEM than for breast MRIs.
In terms of reimbursement, 60% reported receiving some level of payment for the service, 67% of whom said they are paid the full amount. Sources of reimbursement vary based on hospital type, with public hospitals and universities relying on public funding and private hospitals receiving payment via insurance.
Of the 40% of the providers who indicated their organization is not paid for CEM, most cited the lack of a dedicated billing code or absence of reimbursement by the national healthcare system and/or insurance providers as the reason; around half said they continue to bill for CEM using the full field digital mammography code. The majority signaled they are aware of ongoing efforts to establish a code.
Over half of respondents said the lack of reimbursement did not affect their organization’s decision to implement CEM.
In the U.S., CEM is approved for use as a diagnostic tool but not in screening. However, similar to some other countries, this has not stopped providers from utilizing it in patients who would benefit from contrasted imaging. While reimbursement typically lags behind the implementation of any emerging technology, the authors suggested that more needs to be done to close the loopholes preventing coverage of these beneficial exams.
“There is a strong need for further initiatives and improved coding practices including national registration and declaration codes that comprehensively cover all aspects of the technique in both the public and private sectors,” the group concluded.
Read more about their findings here.
In addition to her background in journalism, Hannah also has patient-facing experience in clinical settings, having spent more than 12 years working as a registered rad tech. She began covering the medical imaging industry for Innovate Healthcare in 2021.