The Centers for Medicare and Medicaid Services Issues Ruling on 2015 Reimbursement Rates

BEDFORD, Mass., Oct. 31, 2014 /PRNewswire/ -- Hologic, Inc. (NASDAQ: HOLX) announced today that the Centers for Medicare and Medicaid Services (CMS) has released reimbursement rates for screening and diagnostic 3D mammography. The action establishes national average payment rates for the Category I Current Procedural Terminology (CPT) code for 3D screening mammography and creates a new add-on Healthcare Common Procedure Coding System (HCPCS) code for 3D diagnostic mammography.

The Medicare payment rates will go into effect January 1, 2015 and will allow providers in the U.S. to file reimbursement claims specific to screening and diagnostic 3D mammography. The CMS Medicare Physician Fee Schedule Final Rule issued today not only sets reimbursement rates for 3D mammography, but also creates a pathway for private insurers to explore broader coverage and payment options. The rates are as follows:

• 3D screening mammography CPT code, 77063, assigned a payment rate of approximately $57. This is an add-on to the existing 2D mammography screening code, G0202, with an assigned payment rate of approximately $135.
• 3D diagnostic mammography HCPCS code, G0279, assigned a payment rate of approximately $57 for either unilateral or bilateral images.    
  • This is an add-on to the existing 2D mammography unilateral diagnostic code, G0206, with an assigned payment rate of approximately $130. 
  • This is an add-on to the existing 2D mammography bilateral diagnostic code, G0204, with an assigned payment rate of approximately $165.

"The availability of reimbursement for 3D mammography is yet another validation of the importance of this game-changing technology in the screening and detection of breast cancer," said Peter J. Valenti III, Division President, Breast and Skeletal Health Solutions. "With the extensive body of published studies, including the landmark JAMA study, Hologic continues to lead the way in introducing superior 3D mammography worldwide."

"Hologic's 3D mammography is currently the only FDA approved system clinically proven to improve upon the accuracy of traditional mammography by significantly increasing the detection of invasive cancers, the cancers doctors worry about, while simultaneously reducing unnecessary callbacks," Mr. Valenti noted. "As a result, we are seeing increasing demand from physicians and patients seeking the best option for screening and detection. Ultimately, we believe this reimbursement will benefit women and healthcare systems throughout the U.S. and we hope that the new Medicare payment rates will allow more women access to this potentially life-saving exam."

About Hologic's Genius 3D Mammography:

Hologic's Genius 3D mammography is the only 3D exam approved by the FDA as clinically superior to traditional mammography. Genius 3D mammography detects significantly more invasive cancers and reduces unnecessary call backs when compared to traditional mammography. In a recent study published in the prestigious Journal of the American Medical Association (JAMA), researchers reported that Hologic's 3D technology detects 41% more invasive breast cancers while significantly reducing anxiety-provoking callbacks due to false alarms.¹

Hologic's 3D mammography technology was approved for breast cancer screening and diagnosis in the U.S. in February 2011 and has been available in countries recognizing the CE mark since 2008. With over 2,000 systems installed worldwide, Hologic's 3D mammography technology is in use in all 50 states and over 50 countries. Over 8 million women in the U.S. have already had a Hologic Genius 3D mammography exam. Genius 3D mammography is only available on the Hologic Selenia Dimensions system. For more information, visit www.Genius3DMammography.com.

About Hologic, Inc.:

Hologic, Inc. is a leading developer, manufacturer and supplier of premium diagnostic products, medical imaging systems and surgical products. The Company's core business units focus on diagnostics, breast health, GYN surgical, and skeletal health. With a unified suite of technologies and a robust research and development program, Hologic is dedicated to The Science of Sure. For more information on Hologic, visit www.hologic.com.

Hologic, Dimensions, Genius 3D mammography, Selenia, and associated logos are trademarks and/or registered trademarks of Hologic, Inc. and/or its subsidiaries in the United States and/or other countries.

Forward-looking Statement Disclaimer:

This News Release may contain forward-looking information that involves risks and uncertainties, including statements about Hologic's 3D mammography technology. There can be no assurance this product will achieve the benefits described herein and that such benefits will be replicated in any particular manner with respect to an individual patient as the actual effect of the use of the product can only be determined on a case-by-case basis depending on the particular circumstances and patient in question. Hologic expressly disclaims any obligation or undertaking to release publicly any updates or revisions to any such statements presented herein to reflect any change in expectations or any change in events, conditions or circumstances on which any such statements are based.

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1} Friedewald SM, Rafferty EA, Rose SL, Durand MA, Plecha DM, Greenberg JS, Hayes MK, Copit DS, Carlson KL, Cink TM, Barke LD, Greer LN, Miller DP, Conant EF. Breast cancer screening using tomosynthesis in combination with digital mammography. JAMA. 2014 Jun 25;311(24):2499-507. doi: 10.1001/jama.2014.6095.

SOURCE Hologic, Inc.

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