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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: 3D Mammography
The 3D portion of your screening mammogram is currently covered by most major insurance carriers, including Medicare and NC Medicaid.
We strongly recommend that you verify coverage with your carrier before your appointment. Wake Radiology offers payment plans for all exams, including 3D mammograms. Our breast imaging radiologists believe so strongly in this advanced technology we don’t want costs to keep you from having this potentially lifesaving screening. 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.
- Insurance for screening mammograms for women 40 years and older Screening mammograms are addressed by the Affordable Care Act (ACA) of 2010. The ACA health insurance reform legislation was passed by Congress and signed into law by President Obama on March 23, 2010. The ACA (also known as “Obamacare”) outlines the requirements for health plans to cover women’s preventive healthcare services, including screening mammography every 1-2 years for women 40 years and older, without cost sharing. Health plans are required to provide these preventive services only through an in-network provider. A patient’s health plan may allow her to receive these services from an out-of-network provider, but may charge her a fee. Wake Radiology recommends that patients check with their insurance carrier before scheduling their annual mammogram to confirm coverage and payment. Learn about Medicare and Medicaid
- Insurance for screening mammograms for high-risk patients under 40 years For women with private insurance, the cost of a baseline mammogram or annual mammograms for younger women who have a family history of breast cancer is typically covered without copayments or deductibles. Wake Radiology recommends that patients check with their insurance carrier before scheduling their baseline or annual mammogram to confirm coverage and payment. Learn about Medicare and Medicaid
Bone Density Scans for Adults (DXA)
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 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)
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
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
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
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.