Overview of different reimbursement strategies among contrast-enhanced mammography (CEM) expert centers on a global level - A survey study

Objectives: To perform an international survey among global expert breast radiologists regarding contrast-enhanced mammography (CEM) on the topic of reimbursement strategies. Methods: An online questionnaire on CEM reimbursement strategies was distributed to 29 selected global expert breast radiologists regarding CEM. Hospital information, CEM implementation, estimated costs, reimbursement availability, registration and declaration codes, as well as personal opinions on CEM reimbursement, were collected. Replies were analyzed using descriptive and non-parametric statistics. Results: Twenty out of 29 global expert breast radiologists regarding CEM responded to this survey. All respondents had implemented CEM at their hospitals between 2011 and 2024 and offered CEM for clinical/diagnostic indications, CEM price ranges were lower than MRI at all but two sites. Sixty percent of hospitals (12/20) reported receiving reimbursement for CEM. The remaining 40% declared not receiving reimbursement, citing reasons such as coverage by department budget, lack of dedicated billing code, or absence of reimbursement by the national healthcare system and/or insurance providers. Among the 12 hospitals receiving reimbursement, 67% (8/12) obtained full reimbursement for all components of CEM, and 75% (9/12) for all indications. Reimbursement sources varied by hospital type, with public and university hospitals mainly publicly funded, and private hospitals relying on insurance or patient payments. Most respondents (75%, 15/20) reported that no dedicated national reimbursement code for CEM currently exists. Of these respondents, 53% (8/15) used the FFDM code. Most hospitals lacked separate codes for the contrast medium (60%, 9/15) or its intravenous injection (93.3%, 14/15). Among hospitals without a national code, 73% (11/15) were aware of efforts to establish one. Although nearly half of the participants (45%, 9/20) faced reimbursement challenges, 65% (13/20) stated that reimbursement strategies did not affect their CEM adoption. Conclusion: Substantial heterogeneity in CEM reimbursement strategies exist, with most hospitals securing full coverage through alternative strategies until dedicated national reimbursement codes are established.