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Sage Program Changes Frequently Asked Questions
On Feb. 1, 2024, Sage will no longer provide payment for:
- Breast and cervical cancer screening and diagnostic services for women, including transgender males and females, 21 to 29 years of age.
- Breast and cervical cancer screening and diagnostic services for those ages 65 and older.
- Magnetic Resonance Imaging (MRI).
- More than one office visit CPT charge for each eligible client per date of service. Sage will pay for one office visit CPT per date of service billed on a professional claim OR one office visit CPT per date of service billed on an institutional claim.
Q: What services will Sage pay for?
A: Sage Cancer Screening Program will enroll and pay for:
- Breast cancer screening and diagnostic services for women, including transgender males and females
- Ages 40 to 64.
- Ages 30-39 when presenting with a family history, symptoms, or an abnormal screening result.
- Cervical cancer screening and diagnostic services for those ages 30-64.
Q: Will Sage continue to work with all its active participating providers in the program network?
A: Yes, Sage will uphold all active provider agreements by continuing to work closely with Sage partner clinics to recruit and enroll Sage-eligible patients and cover the costs of their breast and cervical cancer screening and diagnostic services.
Q: Why is Sage making changes to their services?
A: Sage received a substantial funding cut at the start of their current CDC five-year funding cycle that began in July 2022. We must implement changes to program services to conserve resources, with the goal of allocating cost savings to direct screening so that we can continue to screen as many individuals as possible.
Q: What happens when a clinic enrolls a patient for Sage services who no longer qualifies?
A: As of Feb. 1, 2024, Sage will no longer cover screening and diagnostic services for those who do not meet new eligibility criteria.
Q: How do these changes affect patients who are eligible for MA-BC (medical assistance for breast and cervical cancer)?
A: These Sage Program changes do not affect patients who are eligible for MA-BC. Sage staff will continue to collaborate with the clinic and the Department of Human Services to enroll Sage patients who are eligible for MA-BC.
Q: What resources exist for individuals ages 21-29 who are no longer eligible to receive screening and diagnostic services through Sage?
A: Individuals may qualify for the Minnesota Family Planning Program (MFPP), which offers no-cost office visits for family planning, birth control, STD testing/treatment, and other services. Visit the Minnesota Department of Human Services Minnesota Family Planning Program website to see eligibility criteria.
Individuals ages 21-64 may qualify for Medical Assistance (MA) or MinnesotaCare. Visit the Minnesota Department of Human Services website to see eligibility criteria:
MNsure is Minnesota's health insurance marketplace where individuals and families can shop, compare and choose health insurance coverage that meets their needs. MNsure is the only place you can apply for financial help to lower the cost of your monthly insurance premium and out-of-pocket costs. Most Minnesotans who enroll through MNsure qualify for financial help. Visit the MNsure website to learn more.
Planned Parenthood may also offer low-cost Pap smears. Planned Parenthood is an organization that offers sexual and reproductive health care to individuals, regardless of income. You can find your local Planned Parenthood clinic by visiting their website or calling (800) 230-PLAN.
Q: What resources exist for individuals 65 and older who are no longer eligible to receive screening and diagnostic services through Sage?
A: The Senior LinkAge Line can assist older adults with signing up for Medicare. Individuals can call Minnesota's Senior LinkAge Line at 800-333-2433 or visit Minnesota Senior Linkage Line Medicare webpage:
Medicare is health insurance for people 65 or older, or for those who have certain chronic diseases. Some people get Medicare automatically, others have to actively sign up - it depends if you start getting retirement or disability benefits from Social Security before you turn 65. Visit Medicare.gov for more information.
Minnesota Area Agencies on Aging (AAAs) are regional organizations that provide the services, supports and information for just about everything that older adults and their families could need. Minnesota has seven AAAs across the state that are the local connections to older Minnesotans and the community support they need as they age.
Q: Do these changes to the Sage Breast & Cervical Program affect the SagePlus and/or Cancer Screening Quality Improvement (CSQI) Programs?
A: No, the Sage Breast and Cervical Screening Program changes do not affect the CSQI or SagePlus Programs.
Q: Are there exceptions to the breast cancer screening age requirements for individuals younger than 40 years of age?
A: Those 30-39 years of age presenting with a family history, symptoms, or an abnormal screening result are eligible for Sage breast cancer screening and diagnostic service coverage.
Q: What happens if patients had an appointment prior to Feb. 1, 2024, but need to postpone it to after Feb. 1, 2024, and may no longer be eligible for Sage?
A: Sage will cover screening services conducted prior to Feb. 1, 2024, and if screening results are abnormal, Sage will cover the associated diagnostic services prior to June 30, 2024.
Q: Regarding the program change that Sage will no longer cover more than one Office Visit CPT code – Does this mean patients will have to come back another day for imaging if a provider finds a palpable lump during a breast exam?
A: Sage patients can receive needed imaging on the same date of service as an office visit. Sage will pay for an office visit CPT and necessary screening or diagnostics on the same date of service that are covered by Sage. This program change of allowing only one Office Visit CPT code pertains to Sage providers who would charge Sage for two office visit CPTs on the same day for both a professional claim or institutional claim.
Q: Is Sage going to send notification to former Sage program patients who are no longer eligible?
A: Yes. Sage Program staff send annual reminder letters to patients who are due for screening that have used the Sage Program in the past. Sage will modify these reminder letters to include information about updated patient eligibility and will include resources and referral information about low-cost screening clinics for those individuals who no longer qualify for Sage.