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June 2016

Let patients know that Blue Cross doesn’t cover digital breast tomosynthesis

We continue to receive a large number of member appeals related to digital breast tomosynthesis, also known as 3D mammography.

Be sure to let your patients know that Blue Cross Blue Shield of Michigan doesn’t cover this procedure for its members, with the exception of Medicare Advantage, Federal Employee Program® and MESSA members. Blue Cross members who choose to have the procedure when it’s not covered should sign a waiver stating that they understand they will be financially responsible for the cost.

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

Blue Cross considers digital breast tomosynthesis experimental for both the screening and diagnosis of breast cancer, and our contracts with providers exclude coverage for experimental services or procedures. Most other plans also consider the procedure to be experimental or investigational.

Keep in mind that if you determine that additional imaging is necessary for a patient, Blue Cross reimburses for other imaging procedures beyond conventional mammography.

We’ll continue to review the policy on digital breast tomosynthesis on an ongoing basis. If the policy changes, we’ll notify you through The Record.

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

  • Go to bcbsm.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.
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*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2015 American Medical Association. All rights reserved.
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