2024 NYSDOH Breast Cancer Surgery Policy Letter
Research has consistently demonstrated that patients undergoing breast cancer surgery at high-volume facilities experience higher five-year survival rates. As a result, NYS DOH has instituted a policy to ensure that NYS Medicaid members receive mastectomy and lumpectomy procedures associated with a breast cancer diagnosis at high-volume hospitals and ambulatory surgery centers.
Effective April 1, 2024, NYS DOH has identified and restricted 215 low-volume hospitals and ambulatory surgery centers throughout NYS from receiving reimbursement for breast cancer surgeries provided to NYS Medicaid members. These facilities have been duly notified of the restriction. It’s important to note that this policy does not hinder these facilities from offering diagnostic or excisional biopsies and post-surgical care (such as chemotherapy, radiation, reconstruction, etc.) to NYS Medicaid members.
To ensure that NYS Medicaid members receive care at high-volume facilities, I encourage you to please refer to the NYS DOH “Hospitals & Ambulatory Surgery Centers Where Medicaid Will Pay for Breast Cancer Surgery” web page. This resource furnishes a comprehensive list of hospitals and ambulatory surgery centers where Medicaid will cover breast cancer surgeries for NYS Medicaid members.
NYS DOH “Hospitals & Ambulatory Surgery Centers Where Medicaid Will Pay for Breast Cancer Surgery” web page.
NYS DOH “Hospitals & Ambulatory Surgery Centers Where Medicaid Will Not Pay for Breast Cancer Surgery” web page.
Thank you for your attention to this matter. We appreciate your continued dedication to providing exceptional care to your patients and to our members.
