Diagnostic Mammography Coverage Mandate
January 27, 2017There is a New York state coverage mandate going into effect January 1, 2017, expanding the existing health insurance benefit for screening mammography to include diagnostic imaging for the detection of breast cancer. The expanded services include diagnostic mammograms, breast ultrasounds, digital breast tomosynthesis and MRIs, in addition to already covered screening mammograms. The mandate applies only to commercial lines of business. Coverage of diagnostic imaging services will be provided to members regardless of age or gender without cost sharing (copayment, deductible, or coinsurance). There will be no limitations on the frequency of diagnostic imaging services. The mandate does not apply to members who have Child Health Plus, Premier Child Health Plus, HMOBlue Option, Blue Choice Option, Premier Option, Blue Option Plus, Premier Option Plus, Medicare Advantage, Medicare Supplemental or self-funded coverage. Be sure to check member eligibility and benefits prior to the service being delivered