Did You Know?
Wake Radiology is right-sized just for you.
+ Large enough to serve you, small enough to know you
+ outpatient locations throughout the Triangle, many with weekend, evening and early morning hours.
+ All images are read and interpreted by a board certified, subspecialty trained radiologist right here in the Triangle.
Screenings and Insurance
Screenings covered by Medicare and private insurance companies require that certain criteria be met. Wake Radiology recommends that patients check with their insurance carrier before scheduling their screenings to confirm coverage and payment. Exams that are not covered by payors are considered out-of-pocket procedures and are payable at the time of service. With the exception of an annual screening mammogram, all screening studies performed at Wake Radiology require a signed physician referral – regardless of insurance coverage.
Breast Cancer Screenings: 2D and 3D Mammography
Breast cancer is the most common cancer in women worldwide. A mammogram can detect cancer early, when it is most treatable. Even though this is the case, nearly a third of American women currently do not get regular mammograms. Screening mammograms do not require a physician’s order. Wake Radiology simply requires that eligible patients have visited their physician within the past 18 months. Wake Radiology now offers both 2D and 3D mammography at most Wake Radiology locations throughout the Triangle.
|Calculate your breast cancer risk|
If you choose to have a 3D Mammography (Tomosynthesis) there will be an additional cost of $60. The screening mammogram will be filed with your insurance carrier in two parts: The 2D mammogram fee and a $60 Tomosynthesis (3D mammogram) fee. 2D screening mammograms are covered by health insurance under the Affordable Care Act. Some insurers will not cover the 3D mammogram charge because the technology is newer. Medicare patients won’t have an out of pocket expense with a screening 3D mammogram as Medicare began covering the service in 2015. If your insurance carrier does not cover the 3D portion of your mammogram, you will receive a bill from Wake Radiology for $60. Don’t let the cost of the 3D mammogram keep you from choosing this breakthrough technology, Wake Radiology regularly provides payment plans to help patients manage the costs of care, including 3D mammography. We are happy to extend payments over time (without interest or additional fees) to assist you. Wake Radiology is the first outpatient practice in the Triangle to earn the American College of Radiology’s prestigious Breast Imaging Center of Excellence (BICOE) designation.
Click here to read the recommendation from the ACR and Society of Breast Imaging. According to the National Cancer Institute and the Centers for Disease Control, the risk of a woman age 40 – 50 developing breast cancer is 1/68.
Women and their doctors should know that the American Cancer Society has always, and still does, state that annual mammography screening starting at age 40 saves the most lives. The US Preventive Services Task Force (USPSFT) also acknowledges this fact, as stated in their recent draft recommendations: “The USPSFT found adequate evidence that mammography screening reduces breast cancer mortality in women age 40 -74 years“.
A baseline mammogram is the name used for a patient’s first screening mammogram. It is important because it is usually used as the basis for comparison in later tests. Wake Radiology also recommends that women continue self-exams each month to detect changes in their breasts. We also advise women to have a yearly clinical exam by their primary healthcare provider.
Bone Density Scans for Adults (DXA)
25 million Americans have osteoporosis, nearly 80% of which are women. Said another way, 1 in 4 women has osteoporosis, making them 10 times more likely to suffer from this disease than men. The determining risk factors include:
In the past, osteoporosis could be detected only after patient broke a bone. By that time, however, the bones could be quite weak. A bone density test (DXA) is a non-invasive, accurate and inexpensive way to know a patient’s risk of breaking bones before the fact. It uses X-rays to measure how many grams of calcium and other bone minerals are packed into a segment of bone. The bones that are most commonly tested are located in the spine, hip and forearm. The procedure takes 15-30 minutes and requires a signed physician referral. Wake Radiology is the only imaging group in the Triangle to be certified by the International Society of Clinical Densitometry (ISCD) for bone density exams. All DXA studies are read by fellowship-trained orthopedic radiologists who are ISCD certified.
|Calculate your risk of fracture|
Bone density scans and insurance
DXA is covered under the Affordable Care Act of 2010, with no cost sharing (ACA covered preventive services for Medicare as of January 1, 2011). Medicare Part B medical insurance covers this once every 24 months or more often if medically necessary. All qualified people with Medicare who are at risk for osteoporosis and meet one of the following five criteria are covered:
- A woman whose doctor is treating her for estrogen-deficiency and at risk for osteoporosis based on her medical history or other findings.
- A person with vertebral abnormalities as demonstrated by an X-ray.
- A person getting steroid treatments.
- A person with hyperparathyroidism.
- A person taking an osteoporosis drug.
For patients who do not meet the above criteria, some insurance companies may or may not cover the cost of the scan. Coverage will likely be based on the referring physician’s assessment of a patient’s risk factors. Wake Radiology recommends that patients check with their insurance carrier before scheduling their bone density scan to confirm coverage and payment.
PET-CT Amyvid Studies to Help Rule Out Alzheimer’s Disease
Wake Radiology physicians are among the first in the area to interpret cutting edge Amyvid (florbetapir) PET-CT studies that can help rule out Alzheimer’s Disease. Amyvid is the first FDA-approved agent for PET-CT brain imaging of amyloid plaques in patients with cognitive impairment who are being evaluated for Alzheimer’s and other causes.
Amyvid and insurance
Amyvid is not currently covered by Medicare or any major insurance plans. Lilly’s Reimbursement Support Program includes a call center (1-877-9-AMYVID or 1-877-926-9843 Monday-Friday, 8am-8pm ET) and web-based resources to assist with Amyvid reimbursement for patients, including:
- General coverage inquiries
- Benefits investigations
- Billing and coding information
- Assistance with prior authorization and precertification
Abdominal Aortic Aneurysm Ultrasound Screenings (AAA)
Men – especially those over 65 – are four+ times more likely than women to develop an abdominal aortic aneurysm (AAA). These aneurysms usually occur in the aorta, just below the kidneys. Early on in their development, patients will not notice any pain or discomfort. As they enlarge, however, patients may have intermittent back or abdominal pain. Larger aneurysms can burst and lead to death within a few minutes. Abdominal aortic aneurysm (AAA) screenings use ultrasound to easily detect these aneurysms. Referring providers and their patients use the results to determine how best to monitor (e.g., with subsequent ultrasound studies) or manage it (e.g., catheter procedure, surgery or medication). The risk criteria include:
AAA and insurance
Since 2005, Medicare has paid for a one-time preventive ultrasound screening for early detection of AAAs for at-risk patients. The Affordable Care Act of 2010 covers this exam one time for men of specified ages who have ever smoked. Listed under For Medicare Part B, patients must get a referral from their doctor for it as a result of their “Welcome to Medicare” preventive visit. People with Medicare who are eligible for an abdominal aortic aneurysm screening must meet one of these criteria:
- They have a family history of abdominal aortic aneurysms
- They are a man age 65 to 75 and have smoked at least 100 cigarettes in their lifetime
This “Welcome to Medicare” study is covered and Wake Radiology requires a signed physician order. When this exam is performed for diagnostic purposes, insurance coverage must be confirmed. Wake Radiology recommends that patients check with their insurance carrier before scheduling their AAA screening to confirm coverage and payment.
CT Coronary Calcium Scoring
Nearly 1.5 million Americans will have a heart attack this year and one third of them will die. Half of patients suffering their first cardiac event will have no prior warning or symptoms and more than 80 percent of high risk patients will have a “normal” result on a standard treadmill test. CT coronary calcium scoring is the single most accurate assessment of heart attack risk. This painless, non-invasive test is endorsed by the American Heart Association and is the only non-invasive method that can directly identify atherosclerotic plaque buildup in the coronary vessels. CT images show all calcified plaques in the coronary arteries. The total amount of disease (plaque) is calculated to determine the calcium score, which accurately predicts a patient’s probability of heart attack over the next few years. The calcium score allows referring physicians to aggressively treat their patients who are discovered to be at high risk. While calcium scoring can be useful for patients thought to be at low, intermediate, and high risk for coronary artery disease, it is typically recommended for men over age 45 and postmenopausal women more than age 55 who also have one or more major risk factors for heart attack:
|Calculate your risk of a heart attack|
CT coronary calcium scoring and insurance
Medicare and most insurance companies do not pay for this study. The study costs $350 and Wake Radiology requires a signed physician order. Wake Radiology recommends that patients check with their insurance carrier before scheduling their CT coronary calcium scoring study to confirm coverage and payment.
CT Lung Cancer Screenings
Lung cancer remains the leading cause of death from cancer in this country. Individuals at high risk for lung cancer now have access to a low dose, low cost screening procedure. Because CT scans can depict tumors significantly smaller than 1.0 centimeter in size, we have the potential to detect lung cancer in its very early stages before disease progression. This highly sensitive, low dose, CT scan of the chest targets the lung fields only. No special preparation is required, and patients can be in and out of our office in approximately 15 minutes.
CT lung cancer screening and insurance
Beginning in January 2015 low-dose lung cancer screenings became a covered service by Medicare and commercial insurance carriers through the Affordable Care Act. Coverage criteria varies so Wake Radiology recommends that patients check with their insurance carrier to see if they qualify for this screening. A signed physician referral is required to schedule this exam.
Colon Cancer Screenings: Barium Enemas
Colon cancer is the third most commonly diagnosed malignancy in developed countries and the second leading cause of cancer deaths in men and women. Symptoms of colon cancer include:
- Blood in the stool
- Abdominal cramping
- Intestinal blockage or change in bowel habits (usually unnoticed until the disease has progressed)
Early-stage colon cancer is curable, which makes screening and early diagnosis important. Pre-cancerous growths found during screening can be removed before they develop into cancer. The American Cancer Society risk factors include:
Wake Radiology performs barium enema exams for patients who cannot tolerate the sedation required for colonoscopy. The procedure uses barium to provide contrast inside the colon. X-rays can reveal polyps or other abnormalities. Most patients easily undergo this exam and there is often no recovery required.
Barium enema colon cancer screenings and insurance
Medicare and major insurance companies cover this screening. Wake Radiology recommends that patients check with their insurance carrier before scheduling their this study to confirm coverage and payment.