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Breast tomosynthesis screening, 3-D mammography, will be covered by fully-insured commercial plans starting Jan. 1

01/10/2017

We will cover breast tomosynthesis screening, a three-dimensional mammogram, for all our fully-insured commercial members in 2017. The member's cost-share will depend on his or her benefits plan.

Preauthorization will not be required for this service, which the state of Connecticut mandates be included in all fully-insured individual and employer-sponsored plans that are new and renewing after Jan. 1, 2017.

Our coverage of this service, identified with a procedure code of 77063, will be as follows:

  • For employer-sponsored large group plans, we will cover the service as preventive as long as it is coded and meets the same age and frequency requirements as a routine, preventive annual mammogram:
    • Procedure code: 77063
      Frequency: Once a year*
      Other requirements: women age 40 and older
    • The member will have no cost-share if these guidelines are followed.
    • If these guidelines are not followed, then the member will have to pay any applicable non-advanced radiology cost-share listed in his or her benefits plan.
    • Coverage will begin only after a large group renews on or after Jan. 1. So if one of your patients has a plan that will renew on Feb. 1, 2017, we will only cover the service if the claim was submitted with a date of service on or after Feb. 1, 2017. Any claims submitted prior to the renewal date will be denied.
  • For Connecticut small group and individual plans, which include ConnectiCare SOLO and ConnectiCare plans sold through AccessHealth CT, the state insurance exchange, we will cover the service, and the member will have to pay the applicable non-advanced radiology cost-share as listed in his or her benefits plan.
    • Coverage will begin only after the plan renews on or after Jan. 1. So if one of your patients has a plan that will renew on Feb. 1, 2017, we will only cover the service if the claim was submitted with a date of service on or after Feb. 1, 2017. Any claims submitted prior to the renewal date will be denied.

*Please note: employer-sponsored plans for municipalities do not have visit limitations.