Reimbursement Policy

CDC recently convened two panels of experts to provide recommendations for NBCCEDP screening reimbursement policies. The independent, expert panels were composed of 30 people representing academia, industry, professional organizations, the health care sector, the public health community, and the federal government.

One panel reviewed breast-screening technologies, including film mammography (conventional), full field mammography, computer-aided detection (CAD), magnetic resonance imaging (MRI), and ultrasound. The second panel reviewed cervical cancer screening technologies, including conventional cervical cytology, liquid-based cervical cytology, and human papillomavirus (HPV) testing (as replacement for, and an adjunct to, screening cytology).

Guided by the panel's recommendations, the NBCCEDP released the following revised screening reimbursement policies:

• The NBCCEDP will continue to reimburse conventional film mammography.



• The NBCCEDP will reimburse the use of digital mammography at the reimbursement rate for conventional film mammography. Currently, there is insufficient evidence that digital mammography yields a greater reduction in incidence and mortality.



• The NBCCEDP will not reimburse the use of CAD. Currently, there is insufficient evidence that CAD contributes to greater reductions in mortality and morbidity.



• The NBCCEDP will reimburse neither the use of MRI nor the use of ultrasound as screening technologies. The NBCCEDP will continue to reimburse the use of ultrasound as a diagnostic tool.



• The NBCCEDP will continue to reimburse conventional cytology annually and then every 3 years for women with three consecutive normal Pap tests within a 5-year period.



• The NBCCEDP will reimburse liquid-based cervical cytology for biennial primary cervical cancer screening, up to the allowable Medicare rate. As with conventional Pap tests, when a woman has had three consecutive, normal cervical cancer screening tests documented within a 60-month period, the screening interval will increase to once every 3 years.



• The NBCCEDP will continue to reimburse HPV testing, if the testing is used as follow-up to a screening exam that found atypical squamous cells of undetermined significance (ASC-US), or for surveillance 1 year following a Pap test that found a low-grade squamous intraepithelial lesion (LSIL) without evidence of cervical intraepithelial neoplasia (CIN) on colposcopy-directed biopsy.