Medicaid Coverage for 3D Mammography/Tomosynthesis

On January 8, 2019 – Mark Isenberg, EVP of Healthcare Advocacy for Zotec Partners had a face to face meeting with Ms. Christina Corieri, Senior Policy Advisor to Governor Ducey to discuss why Arizona remains one of a handful of states that does not cover 3D Mammography/Tomosynthesis for their Medicaid population. At the meeting, with the assistant of a board-certified breast radiologist, we walked them through the clinical reasons why 3D mammography is now the standard of care according to Medicare and the ACR. We provided them with documentation on how covering and requiring that 3D become the standard of care could reduce their overall Medicaid spending. Additionally, we shared data on decreased callbacks for false positives and the reduced costs associated with treating cancer at an earlier stage.  The information provided was compelling and they are taking this into consideration. Any change to Arizona's coverage policy would not be implemented until October 2019. They are going through the process of trying to understand what reimbursing for this code would do to their capitation, as well as reviewing the materials with the Chief Medical Officer at AHCCCS to understand the clinical benefits. I would encourage you to contact Governor Ducey and let him know that you are supportive of this coverage change. 

Please click here to take a few minutes to contact the Governor and voice your support.

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