Table Of Content1994-1995
MAMMOGRAPHY
SERVICES
PAID BY MEDICARE
State and County Rates
DEPARTMENT OF
j.
HEALTH AND HUMAN SERVICES
Health Care Financing Administration
MEDICARE•MEDICAID
U.S. Department ofHealth and Human Services
Donna E. Shalala, Secretary
Health Care Financing Administration
Bruce C. Vladeck, Administrator
Nancy-Ann Min DeParle, Deputy Administrator
Office ofStrategic Planning
Barbara S. Cooper, Director
Thomas A. Gustafson, Ph.D., Deputy Director
Research and Evaluation Group
Alfonso E. Esposito, Director
Division ofBeneficiary Research
Paul W. Eggers, Ph.D., Director
David Baugh, Publication Coordinator
1994-1995
MAMMOGRAPHY
SERVICES
PAID BY MEDICARE
State and County Rates
October 1997
4? u S DEPARTMENT OF
i JfT HE- A-LTH AND HUMAN SERVICES
\ ^^ 71
V- Health Care Financing Administration
MEDICARE•MEDICAID
4
DEPARTMENT OF HEALTH & HUMAN SERVICES
Health Care Financing Administration
The Administrator
Washington, D.C. 20201
Dear Colleague:
I am pleased to provide you with a summary ofinformation on mammography services
provided by the Medicare program during 1994 and 1995. This book is part ofthe
Health Care Financing Administration's (HCFA's) effort to educate the public and
the health care community about mammography services covered by Medicare and to
encourage women to use these services to improve their health. The data can also
be obtained from HCFA's Internet home page at the following address:
www.hcfa.gov/stats/mamm/mammover.htm.
There are three notable findings about the utilization ofMedicare-covered mammography
services. First, only 39 percent ofwomen aged 65 or older received mammograms during
1994 and 1995. Second, women ofAfrican-American descent had even lower utilization
rates than Caucasian women. Third, use ofmammography decreases substantially with
age. I am hopeful that the dissemination ofthe data and the public discussion ofits
implications will encourage efforts to improve access and utilization ofthese services.
The utilization data reflect only those mammography services provided to Medicare
beneficiaries in the fee-for-service setting for which Medicare received a bill. Breast
cancer screening programs that do not generate a Medicare bill (such as those provided
by health maintenance organizations (HMOs)) are not included in the data. The technical
notes in the report provide additional details about the data and its limitations.
I would like to express my appreciation to the many individuals at HCFA and our Public
Health Service colleagues, particularly in the National Cancer Institute, the Office of
Women's Health, and the Centers for Disease Control and Prevention, who worked to
develop this material. Credit also goes to our partners in the private sector who are
assisting with the distribution ofthis information and organizing mammography
campaigns nationwide.
The Department ofHealth and Human Services' "Healthy People 2000" goal is to have
60 percent ofwomen aged 50 and older receive mammograms every 2 years. It is clear
that, even with the addition ofmammograms not billed to Medicare, the current
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mammography utilization rate ofAmerican women over age 65 is too low. With your
help, I hope to distribute markedly improved findings in the future as we continue to
monitor and encourage the use ofthis important Medicare-covered preventive service.
Sincerely,
Bruce C. Vladeck
Administrator
Contents
Rationale and Summary
1
National Medicare Mammography Data 3
Technical Notes 9
State and County Medicare Mammography Data
Alabama 13
Alaska 17
Arizona 21
Arkansas 25
California 31
Colorado 35
Connecticut 39
Delaware 43
District of Columbia 47
Florida 51
Georgia 55
Hawaii 63
Idaho 67
. . -
Illinois 71
Indiana 77
Iowa 83
Kansas 89
Kentucky 95
Louisiana 101
Maine 105
Maryland 09
1
Massachusetts 113
Michigan 117
Minnesota 123
Mississippi 129
Missouri 135
Montana 141
Nebraska 145
Nevada 151
New Hampshire 55
1
New Jersey 59
1
v
New Mexico 163
New York 167
North Carolina 171
North Dakota 77
1
Ohio 181
Oklahoma 87
1
Oregon 93
1
Pennsylvania 197
Puerto Rico 201
Rhode Island 207
South Carolina 211
South Dakota 215
Tennessee 219
Texas 225
Utah 235
Vermont 239
Virginia 243
Washington 249
West Virginia 253
Wisconsin 257
Wyoming 263
VI
Mammography Services Paid by Medicare: 1994-95
Rationale and Summary
Key Findings
Older women face a greater risk ofdeveloping breast cancer than younger women. Yet older
women do not take full advantage ofthe life-saving potential ofmammograms to detect breast
cancer early, when it may be cured. The Department ofHealth and Human Services (DHHS)
goal for the Year 2000 is for at least 60 percent ofall older women to receive a mammogram and
a clinical breast exam every two years.
During the 1994 - 1995 period, no State had reached the Year 2000 goal of60 percent. Biennial
rates ofmammography services by State ranged from 32.2 to 48.4 percent. On average,
Caucasians had higher biennial rates (range: 34.0 to 49.0 percent) than African Americans (range:
20.2 to 45.3 percent). However, most rates did increase slightly, between 1 and 4 percentage
points, from the prior 1992-1993 reporting period.
When applied to the approximately 19.5 million elderly Medicare women who receive services in
the fee-for-service sector, these percentages imply over 11.5 million elderly women have not
received a mammogram in the past 2 years. When translated by race, these data imply
approximately 10 million Caucasian women and 1.2 million African American women did not
receive this important Medicare-covered service.
HCFA
Data...
• Reflect the most current biennial data on total mammography use by Medicare women aged
65 and older who are enrolled in the Part A and Part B programs.
• Are based on all mammography claims submitted by providers under Medicare Part B.
• Include Caucasians, African Americans, members ofall other racial groups, and persons of
unknown race in the category "all".
• Exclude approximately 9 percent ofelderly women enrolled in managed care settings, such as
health maintenance organizations (HMOs). Managed care settings do not submit claims for
individual services.
What HCFA Mammography Data Represent
The mammography rates reported in this data book include the two types ofmammograms, those
that were done preventively (screening type) and those that were done because the woman had
suspicious signs or symptoms ofbreast cancer (diagnostic type). Both types are included because
the codes used to bill Medicare for mammograms are not used uniformly by all providers.
Because ofthis variation, Medicare claims cannot reliably distinguish screening and diagnostic
Medicare claims miss some elderly women who have had mammograms. Women who receive
care in managed care settings (like HMOs), or who otherwise obtain an unbilled or free
mammogram cannot be counted via Medicare claims. Free or unbilled mammograms may be
provided by public and private programs administered in hospitals, clinics, mobile vans, or local
YWCA.
organizations such as the
HCFA National Medicare Mammography Campaign
HCFA has developed a plan to provide a framework for guiding the mammography campaign
through the year 2000. The overall goal ofthe mammography campaign is to increase the number
offemale Medicare beneficiaries age 65 and older who receive a Medicare-paid mammogram at
least once every two years. HCFA intends to accomplish this goal in a way that assures equity
among the various diverse populations served by the Medicare program. Therefore, the campaign
will specifically target African-American and Hispanic elderly women and aim to achieve at least a
utilization rate of60 percent by the year 2000.
