What is the 2005 adjustment to the maximum reimbursement for screening mammography?
In December 2004, the Ohio Legislature passed HB 331 to adjust the maximum reimbursement rate for mammography screening to 130% of the Medicare reimbursement rate. The change is effective March 23, 2005. Ohio law requires health plans to pay for screening mammography as part of basic health coverage. Formerly, the law capped the total benefit paid for screening mammography at $85 per year. The new cap is set at 130% of the Ohio Medicare reimbursement rate for screening mammography. The “Medicare reimbursement rate” is the rate paid in Ohio by Medicare for screening mammography that does not include digitization or computer-aided detection, regardless of whether the actual benefit includes digitization or computer-aided detection. If there is more than one Ohio Medicare reimbursement rate for screening mammography, the reimbursement limit is 130% of the lowest Medicare reimbursement rate in the state. The maximum reimbursement rate constitutes full payment and physicians and other provi
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