August 12, 2016

ACR Advocates for Breast Tomosynthesis Coverage

The American College of Radiology has been working with its state chapters to support legislative and regulatory efforts for digital breast tomosynthesis (DBT) and extended hours for screening mammography services and separately with private health insurers to secure coverage for DBT.

Recent legislative actions in several states have favored the DBT’s acceptance:

  • In Illinois, Gov. Bruce Rauner signed Senate Bill 466 into law on July 20 to require insurance plans, including Medicaid, in the state to cover breast tomosynthesis. The law went into effect on July 1, 2016.
  • In Connecticut, Gov. Dannel Malloy signed HB 5233 into law on June 3 to require insurance companies to cover breast tomosynthesis. However, the state insurance commissioner issued a bulletin on July 7 clarifying that breast tomosynthesis is not still considered to be a mammogram by the U.S. Preventive Services Task Force and therefore cost sharing is allowed. The Radiological Society of Connecticut will work with stakeholders to address this issue.
  • In New York, Gov. Andrew Cuomo signed legislation on July 27 that will require breast imaging screening facilities to have extended hours. The extended hours are 7 a.m. to 9 a.m. and 5 p.m. to 7 p.m. Monday through Friday and between 9 a.m. and 5 p.m. on Saturday and Sunday.
  • In Washington State, a bill to provide a “sales and use” tax exemption on DBT and for labor and services died in committee.
  • In California and New Jersey, DBT coverage bills are pending. 

Though Medicare has reimbursed providers for DBT when performed with screening mammography since 2015, the ACR continues to face challenges in persuading private insurance plans to cover DBT. With few exceptions major health care insurance carriers still consider DBT to be an investigational technology. The ACR has developed specific resources to help overcome private payer resistance.