Action

This policy addresses cytologic analysis of breast ductal fluid (obtained invasively or noninvasively, e.g., ductal lavage, nipple aspiration, RPFNA, including devices such as HALO) and breast fiberoptic ductoscopy. Anthem considers these services investigational and not medically necessary; they are not covered for screening, risk assessment (including in high‑risk individuals), detection, diagnosis, or treatment of breast cancer, regardless of acquisition method (CPT/HCPCS 19499 may be reported but is non-covered).

"Cytologic analysis of breast ductal fluid, acquired invasively or noninvasively, is consideredinvestigational and not medically necessaryas a diagnostic or risk assessment tool for those considered..."

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