Effective June 1, 2016, New York State Medicaid fee-for-service (FFS) and Medicaid Managed Care (MMC) will begin covering breast ultrasonography following a patient’s diagnostic mammogram with an abnormal or suspicious finding. Additionally, those enrolled in New York Medicaid FFS and MMC with breast cancer diagnoses will receive their mastectomy and lumpectomy procedures at high-volume facilities. According to research, five-year survival rates increase for women who have their breast cancer surgeries performed at high-volume facilities and by high-volume surgeons.
Breast ultrasonography, also known as ultrasound, is an imaging method that uses sound waves to evaluate breast tissue. It is non-invasive and may aid in distinguishing normal findings like simple cysts or fat lobules from suspicious breast findings that may require a biopsy.
Once the New York Medicaid’s new program initiative comes into effect, breast ultrasonography following a diagnostic mammogram will no longer require an additional order from the primary provider when performed in a hospital setting. Instead, a note in the radiologist’s report will fulfill this requirement.
High-volume facilities that will be able to perform mastectomy and lumpectomy procedures associated with a breast cancer diagnosis for New York FFS and MMS patients are defined as averaging 30 or more all-payer surgeries annually over a three-year period. Low-volume facilities will not be reimbursed for breast cancer surgeries provided to Medicaid beneficiaries. This policy is an ongoing effort to reform New York State Medicaid and to ensure the purchase of cost-effective, high-quality health care and better outcomes for its beneficiaries.
Medicaid is a federally funded program run by the state and the county which provides medical insurance and long-term care for middle- to low-income persons, including the elderly and disabled. P&P Medicaid Consulting Inc. specializes in preparing applications for Medicaid eligibility, guiding you through the document acquiring process and will appear on your behalf at all interviews with the Department of Social Services (Medicaid).
If you are interested in learning more about applying for Medicaid or any of our additional services, call (516) 541-4770 or visit www.ppmedicaid.com.