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November 2015

Reminder: Blue Cross doesn’t cover digital breast tomosynthesis

We want to remind you that Blue Cross Blue Shield of Michigan doesn’t cover digital breast tomosynthesis.

This procedure uses modified digital mammography equipment to obtain additional radiographic data to reconstruct cross-sectional “slices” of breast tissue. Conventional mammography produces 2-D images of the breast.

Digital breast tomosynthesis is considered experimental for both the screening and diagnosis of breast cancer. Blue Cross contracts exclude coverage for experimental services or procedures.

Blue Cross providers can find out whether a procedure is experimental or investigational (not a covered benefit) by following these steps:

  • Go to bcbcm.com.
  • Log in as a provider.
  • Click on web-DENIS.
  • Click on BCBSM Provider Publications and Resources.
  • Click on Provider Manual.
  • Go to Benefit Explainer and enter the necessary information.
No portion of this publication may be copied without the express written permission of Blue Cross Blue Shield of Michigan, except that BCBSM participating health care providers may make copies for their personal use. In no event may any portion of this publication be copied or reprinted and used for commercial purposes by any party other than BCBSM.

*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2014 American Medical Association. All rights reserved.
Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and
independent licensees of the Blue Cross and Blue Shield Association.