Breast Imaging Guidelines

This policy covers diagnostic breast imaging services—including mammography pathways and modalities such as breast ultrasound, breast MRI, and imaging related to breast reconstruction—using BI-RADS–based management to evaluate common breast symptoms and findings. It applies to patients with presentations like nipple discharge, breast pain (mastodynia), and suspected male breast cancer, but limits include that ultrasound is not appropriate as stand‑alone screening (including for density alone), MRI is not indicated in specified scenarios, Category 0 studies require additional imaging or prior comparisons, atypical presentations need physician review, and BI-RADS 3 findings require short‑interval follow‑up at 12, 18 and 24 months with stability then considered benign.

"This tool addresses common symptoms and symptom complexes for breast imaging (diagnostic strategies)."