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Breast Biopsy Reimbursements on the Rise

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Many of you already know this sad story, but for those of you who don't: at the beginning of 2014, the Centers for Medicare & Medicaid Services (CMS) reduced reimbursement for stereotactic needle biopsy procedures in hospitals by nearly 50%, under the Hospital Outpatient Prospective Payment System (HOPPS).

This "cashflow haircut" came as yet another blow to the bottom line of hospitals that have heretofore offered these services regularly, especially those in rural and inner city areas. Fortunately, recent developments could turn things around and leave stereotactic needle biopsy providers with a happy ending after all.

The 2014 Cuts

Some experts have voiced concerns that the 2014 cuts to stereotactic needle biopsy reimbursement could prompt a return to less accurate and more invasive biopsy methods. In an article published on AuntMinnie.com, Mark Gittleman, M.D. of the American Society of Breast Surgeons Coding and Reimbursement Advisory Group said, "Most stereotactic biopsies are performed by radiologists in facility settings, and if they aren't going to be reimbursed for the cost of the procedure, my fear is that these physicians will decide they can't afford to do them, and there will be a return to open excisional biopsies -- to the detriment of both patients and payors."

The 2015 Rebound

On October 31st, CMS fixed payment classes for newly bundled breast biopsy codes. This sweep of the pen is set to increase reimbursement to hospitals by 51% over the 2014 rates. According to the Federal Register, the proposed payment for codes 19081, 19083, and 19085 is $1.062.28 versus $702.08 in 2014.

This is a breath of fresh air for those already providing stereotactic breast biopsy services. For those who have been hesitant to provide this service, this may be just the good news that they have been looking for. If you are considering adding prone, needle-guided, stereotactic biopsy services to your department, you can download our buyer's guide to help answer some of the questions you may have about getting started.

Read more about the ruling on the ACR.ORG Website