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. 2025 Oct:191:112315.
doi: 10.1016/j.ejrad.2025.112315. Epub 2025 Jul 15.

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

Javier Azcona Sáenz  1 , Pascal A T Baltzer  2 , Iris Allajbeu  3 , Allison Rose  4 , Erkin Aribal  5 , Corinne Balleyguier  6 , Chiara Bellini  7 , Almir G V Bitencourt  8 , Jonathan J James  9 , Anat Kornecki  10 , Marc B I Lobbes  11 , Ruth Helena Morais Bonini  12 , Bhavika K Patel  13 , Federica Pediconi  14 , Jordana Phillips  15 , Javier Rodríguez Lucero  16 , Flavia Beatriz Sarquis  17 , Donna Blanche Taylor  18 , Marcela Uchida Silva  19 , Rodrigo Alcantara Souza  20 , Thiemo J A van Nijnatten  21
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Free article

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

Javier Azcona Sáenz et al. Eur J Radiol. 2025 Oct.
Free article

Abstract

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.

Keywords: Breast imaging; Contrast-enhanced mammography; Health Care Surveys; Magnetic Resonance Imaging; Radiologists; Reimbursement; Strategy.

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Conflict of interest statement

Declaration of competing interest The authors declare that they have no know competing financial interests or personal relationships that could have appeard to influence the work reported in this paper.Outside of the submitted work, Javier Azcona Sáenz reports speaker roles for BD, GE Healthcare and Bayer Healthcare. Pascal A.T. Baltzer serves as Secretary General and Board Member of the EUSOBI, and is a steering group member of the Breast Imaging Working Group of the Deutsche Röntgengesellschaft. Iris Allajbeu is a speaker for GE Healthcare and received research funding from Cancer Research UK and the British Center of Research (pending confirmation). Erkin Aribal has received an honorarium from GE Healthcare. Corinne Balleyguier is a speaker for GE Healthcare. Chiara Bellini is a speaker for Hologic and Giotto. Anat Kornecki reports a research collaboration with GE Healthcare. Marc B.I. Lobbes has received speaker's fees from Hologic Inc. and Tromp Medical B.V., and research funding from Hologic Inc. Bhavika Patel has received unrelated research grants from GRAIL Inc. and Hologic Inc., and is a member of the NCCN Breast Cancer Screening Panel. Federica Pediconi is part of the speakers' bureau for Bayer, Bracco, and IMS Giotto, and serves on the advisory boards of Bayer and Guerbet. Jordana Phillips is a consultant for GE Healthcare and Hologic Inc. Rodrigo Alcantara Souza is a member of the speakers' bureau for BD and GE Healthcare. Thiemo J.A. van Nijnatten has received institutional grant support, participated in medical advisory board meetings, and received speaker honoraria from GE Healthcare and Bayer; he also participates in advisory board meetings for ScreenPoint Medical. All other co-authors declare no conflicts of interest.

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