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September 2017
Remind your eligible Medicare Advantage members to get mammograms every two years
Breast cancer is the leading cause of cancer in women. One in eight women will be diagnosed at some point in her lifetime. Yet 20 percent of our female Medicare Plus BlueSM PPO members age 50-74 haven’t had a mammogram in two years.
Breast cancer screening measure
The HEDIS® measure for breast cancer screening is also used by the Centers for Medicare & Medicaid Services as a star rating measure to drive improvements in patient health.
We recommend that you order routine mammograms at least once every 24 months for women ages 50 to 74 to ensure everyone who needs this screening gets it. This can also help to improve HEDIS scores.
Women who had a bilateral mastectomy are excluded from the breast cancer screening measure.
Risk factors may increase screening frequency
Depending on risk factors, more frequent mammograms may be indicated. The biggest risk factor is age. Modifiable risk factors include alcohol use, physical inactivity and excess weight or obesity.
Another risk factor is use of combined estrogen progestin hormone therapy for more than five years after menopause.
Quick tips
- Provide patients with an order for a mammogram and phone number to a local imaging center.
- Follow up with patients after their screenings.
- Document completed mammogram date and exclusion criteria in the medical record.
- When you submit a claim for members with exclusions, please include the following ICD–10–CM diagnosis codes as appropriate:
- Z90.13 — Acquired absence of bilateral breasts and nipples
- Z90.12 — Acquired absence of left breast and nipple
- Z90.11 — Acquired absence of right breast and nipple
- Send all eligible women a reminder card with information about the importance of routine mammograms and stress that it’s a covered preventive screening.
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