Computer-Aided Detection for Mammography (CAD)

The information below may assist you when working with private payers in your locality to assure appropriate coverage of Computer-Aided Detection (CAD) with mammography.  CAD is a computer-based process designed to analyze mammographic images for suspicious areas; in effect, it is a "second pair of eyes" for the radiologist.  The ACR believes that CAD, when used for screening or diagnostic film screen mammography, can be a valuable procedure to aid in the early detection of breast cancer.  The ACR disagrees with certain private payers classifying CAD as investigational, and believes enrollees in private health plans should have access to the same care as Medicare beneficiaries. 

The following information is included below:

  1. A bibliography of articles that outlines the utilization and effectiveness of CAD with mammography. 
  2. A link to the Blue Cross and Blue Shield Association Technology Evaluation Center (TEC) criteria for evaluating technologies.
  3. ACR’s comments to the Centers for Medicare and Medicaid Services (CMS) on the Medicare Physician Fee Schedule Final and Proposed Rules on the Medicare Physician Fee Schedule for 2002
  4. January/February 2003 edition of the ACR Radiology Coding SourceTM
  5. ACR Bulletin article on 2003 CPT Code Update, December 2002
  6. ACR Bulletin article on 2002 CPT Code Update, December 2001
  7. ACR Bulletin article on "New Technology" codes for Mammography, April 2001
  8. Medicare Intermediary Manual (MIM) Transmittal #1842 and Medicare Carriers Manual (MCM) Transmittal #1724, which address the proper coding for computer-aided detection (CAD) performed with screening and diagnostic mammography procedures.

Literature Support for CAD
You may wish to use the literature included on the bibliography below as evidence when working with your private payer to help assure appropriate coverage of CAD with mammography.  

The following points offer additional support for the use of CAD:

  • The Food and Drug Administration (FDA) claimed the use of CAD could increase breast cancer early detection rates by as much as 23.4 percent. 1  
  • As reported in the September 2001 issue of Radiology, Freer and Ulissey2 found a 19.5 percent increase in detected breast cancers when CAD was used.  The study looked at 12,860 mammograms interpreted with assistance from the CAD system over a 12-month period.
  • The American Journal of Managed Care reported that the costs of treating cancer increased from approximately $21,000 in the early stages (stage 0) to over $50,000 for cancers found at late stages (stage IV). 3

Blue Cross and Blue Shield Association Technology Evaluation Center Technology Assessment
The Blue Cross and Blue Shield Association (BCBSA) Technology Evaluation Center (TEC) published a technology assessment of CAD in its November 11, 2002 bulletin.  The objective of the BCBSA TEC technology assessment was to "evaluate the clinical effectiveness of using computer-aided detection (CAD) as an adjunct to mammography."  The BCBSA evaluates a technology against five different criteria/levels of evidence and concluded "use of computer-assisted detection (CAD) after initial radiographic interpretation as a quality adjunct to single-reader mammography meets the Blue Cross and Blue Shield Technology Evaluation Center criteria for patients having film-screen mammography."

The BCBSA TEC maintains that the "use of CAD in patients without a prior independent interpretation of a film-screen mammogram does not meet the TEC criteria.  Finally, use of CAD devices in patients having full-field digital mammography does not meet the TEC criteria."  However, it is important to note that while the BCBSA TEC does state that use of CAD with FFDM does not meet their criteria, the Centers for Medicare and Medicaid Services (CMS) has approved coverage of CAD with FFDM beginning April 1, 2003.  Although this letter does not address CAD for digital mammography, the CMS Program Memorandum announcing coverage of CAD with FFDM is enclosed.

To view the BCBSA TEC’s assessment of CAD, you may visit the BCBSA TEC website at:http://www.bcbs.com/tec/vol17/17_17.html.  For your additional reference, the BCBSA TEC five criteria for technology evaluation can be viewed via the link below.

ACR Position and Coding Resources
The ACR’s comments to the Centers for Medicare and Medicaid Services (CMS) on the Medicare Physician Fee Schedule Proposed and Final Rules on the Medicare Physician Fee Schedule for 2002 are also included.  Please refer to pages 1, 3, and 4 of the December 27, 2001 letter in response to the final rule, and pages 2 and 3 of the October 1, 2001 letter in response to the proposed rule for comments specific to CAD.

The following information regarding coding of CAD is also included below:

  • January/February 2003 edition of the ACR Radiology Coding Source TM
  • ACR Bulletin article on 2003 CPT Code Update, December 2002
  • ACR Bulletin article on 2002 CPT Code Update, December 2001
  • ACR Bulletin article on Mammography, April 2001

Medicare Coverage of CAD
You may also wish to inform the private payer that Medicare covers payment for CAD when used with screening and diagnostic mammography.  Consider if you want to stress that enrollees in a commercial health plan should have the same access to care as Medicare beneficiaries.  The CMS transmittals that address the proper coding for computer-aided detection (CAD) performed with screening and diagnostic mammography procedures are enclosed.

1 FDA Claim, February 5, 2002.  “Use of the ImageChecker could result in earlier detection of up to 23.4% of the cancers currently detected with screening mammography in those women who had a prior screening mammogram 9-24 months earlier.”

2 Freer TW, Ulissey, MJ.  Screening Mammography with Computer-aided Detection: Prospective Study of 12,860 Patients in a Community Breast Center.  Radiology 2001, 220:781-786.

3 McDonough KL. Breast Cancer Stage Cost Analysis in a Manage Care Population. American Journal of Managed Care 1999; v5, no.6 Sup:S377-382.