Oregon payor reverses stand, reinstates CAD payments

In a last-minute reversal, an Oregon insurance payor has withdrawn its recently announced policy that would have eliminated reimbursement for computer-aided detection (CAD) used with all imaging studies, including mammography. The move came just days before the new policy was scheduled to take effect.

In a July 18 letter, ODS Companies of Portland told healthcare providers in its network that it was shelving a policy that had been announced just less than a month before. ODS had told providers in June that it would no longer cover CAD due to negative results for the technology in a recent paper published by the New England Journal of Medicine. The new policy would have taken effect on July 22.

News of the reimbursement cut had created a wave of concern throughout the imaging industry. CAD proponents worried that the move by ODS would prompt other third-party payors to also cut reimbursement for CAD, which many radiologists feel is a valuable adjunct to screening mammography.

In the July 18 letter to providers, ODS medical director Dr. Csaba Mera said that the company decided to rescind the CAD cut after additional review of literature in the area, and after further analysis of the NEJM study.

"While some controversy remains around the value of CAD for mammography, we will await the results of additional well designed studies to make any changes in our coverage of CAD for mammography," Mera said.

By AuntMinnie.com staff writers
July 23, 2007

Related Reading

NEJM study prompts Oregon payor to cancel CAD reimbursement, July 11, 2007

Studies show CAD matches up well with CR mammo, FFDM, May 24, 2007

NEJM study pans CAD, draws attention and criticism, April 5, 2007

CAD boosts single reading of mammograms, September 29, 2006

Multimodality breast CAD workstation improves diagnostic performance, August 17, 2006

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