Important Information About Breast Tomosynthesis

Tomosynthesis Facts

• Breast Tomosynthesis, also known as 3D mammography, is a study performed in conjunction with a traditional “2D” mammogram. Studies have shown that adding 3D mammography improves the detection of some cancers that cannot be seen with traditional “2D” mammograms; a 40% increase in the detection of invasive cancers.
• Tomosynthesis decreases the likelihood that a woman will be called back for additional imaging and incur additional associated costs and anxiety. This happens in approximately 1 out of 10 screening 2D mammograms.
• Tomosynthesis is especially beneficial for women with dense breasts.
• Hoag has been offering Tomosynthesis since 2011 and had the first center in California to offer this technology. Our technologists and dedicated breast radiologists are some of the most experienced in 3D mammography technology.

Tomosynthesis Billing

• Tomosynthesis is a covered benefit of Medicare and Medi-Cal.
• The average charge for 3D mammography across the country is $305. The charge at Hoag is only $132 (including radiologist’s fee). Most patients will pay either $0, or a fraction of the $132.
• The 3D mammography portion of the exam will be billed to the insurance carrier separately from the 2D mammogram. Like any medical procedure or exam, this does not necessarily mean an out-of-pocket expense will be incurred. To verify an out-of-pocket expense, contact the insurance carrier directly with the specific CPT code.
• Explanation of Benefits (EOB) from insurance providers will contain a charge in addition to the traditional mammogram charge for the 3D portion of the study. Hoag does not determine whether this translates into an additional out-of-pocket expense as it depends on a number of different factors including: insurance carrier, the terms of the specific plan coverage, and several other factors (e.g. deductible status, etc.).
• Some private carriers are considering tomosynthesis “investigational” or “not medically necessary” citing that there is no evidence that it reduces mortality. This is a senseless and misleading policy as breast cancer mortality studies require many years and even decades to conduct. 3D mammography is NOT experimental and has been PROVEN in large-scale studies to significantly improve breast cancer detection. If the exam is indicated “investigational” or “not deemed medically necessary,” we encourage patients to contact their insurance carrier and appeal their policy in light of these facts.
• If the EOB indicates that the exam is “investigational”, “not deemed medically necessary”, or “not a covered benefit”, this does not necessarily mean that a bill for the balance will be received. Whether or not a bill is received depends upon a number of factors, including, but not limited to: the specific plan provisions and contractual obligations between Hoag, the radiologist interpreting the exam, and the insurance provider.