Mammography

Aetna covers annual screening mammography for women aged ≥40 and for younger women at high risk (BRCA1/2 carriers, those meeting BRCA testing criteria per CPB 0227, and those with a diagnosis of or first‑degree relative with Bannayan‑Riley‑Ruvalcaba syndrome), and covers BRCA‑positive men with gynecomastia and diagnostic/surveillance mammography for men with prior breast cancer. Screening mammography outside these groups, routine screening for most men, contrast‑enhanced mammography (CESM/CEM), xeroradiography, and low‑dose CT–combined mammography for nipple discharge are considered experimental/investigational or obsolete and not covered.

"Computer-aided detection (CAD) is considered a medically necessary adjunct to mammography."

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