Appropriate Imaging for Breast Cancer Screening in Special Populations

Coverage Decision: Not Covered (Effective date: July 1, 2015)

L&I’s Office of the Medical Director has determined that the HTCC’s decision to cover imaging for breast cancer screening in special populations does not apply to Washington’s workers’ compensation, which covers work-related injuries or occupational disease. The HTCC’s determination involves screening tests for asymptomatic women with average breast cancer risk or with dense breast tissue, which is a general preventative care service usually paid for by primary health insurance.

In rare situations, such as certain work-related radiation or chemical exposure that is believed to increase the risk of breast cancer, L&I may pay for related surveillance imaging tests on a case by case basis.

Background Information

The State Health Technology Clinical Committee (HTCC) reviewed appropriate imaging for breast cancer screening in special populations in January 2015. The committee’s determination, based on a systematic review of the evidence of safety, efficacy and cost-effectiveness, is that digital breast tomosynthesis is a covered benefit in women aged 40 to 74 who are candidates for screening mammography. Supplementary screening with Magnetic Resonance Imaging (MRI), Hand Held Ultrasound (HHUS) or Automated Breast Ultrasound (ABUS) is not covered. Complete information on this HTCC determination is available here: http://www.hca.wa.gov/about-hca/health-technology-assessment/health-technology-reviews.

Billing Codes Affected

CPT and HCPCS Codes: 77059, 77063 and G0202

Regulatory Authority and Related Information

 

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