Breast Imaging Guidelines

Covers breast imaging—screening and diagnostic mammography, breast ultrasound, and breast MRI (including MRI to assess implant integrity)—for patients with breast symptoms, routine screening, or breast implants. Major requirements/limitations: screening studies do not require a recent clinical evaluation, but advanced imaging usually requires a current clinical evaluation (in-person or documented contact) since symptom onset/change, atypical presentations require physician review, MRI is supported only with specified codes (CPT 77049 or HCPCS C8908 for diagnostic MRI; CPT 77047 for implant integrity) and Category 0/Incomplete exams require specified additional imaging before a definitive assessment.

"After 2 years of stability, the finding should be assessed as benign (Cat 2)."

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