The American Medical Association is asking Congress to step in before new Medicare payment cuts go into effect in 2023.

Women with dense breasts or other heightened risk factors for breast cancer may be on the cusp of receiving 100% coverage for additional imaging beyond standard mammography.

 The revisions impact insurers operating on the Affordable Care Act marketplace.

These notifications can sometimes leave many patients feeling even more bewildered about their mammogram results than they were before being made aware of their dense tissue.

The PHE has been in effect since the early days of the pandemic, and it has been reaffirmed every 90 days since. CMS has indicated it will give healthcare stakeholders at least 60 days’ notice before winding down the PHE.

“We must make every effort to grant equitable access to tools that can help individuals and their loved ones treat and manage this disease."

Many patients are unaware of factors that influence how they are billed, such as ancillary fees and organizational setups that use parties offsite to interpret imaging studies. In turn, the pricing information patients receive prior to exams is often incomplete. 

With the midterms in the rearview, the lameduck Congress is focused on a handful of healthcare priorities heading into 2023, including mental health and implementing recent Medicare price negotiations afforded in the Inflation Reduction Act.