Breast Imaging Guidelines

This policy covers breast imaging services including mammography, breast ultrasound, breast MRI (supported codes 77049/C8908 for bilateral MRI with/without contrast and 77047 for MRI in patients with implants), alternative imaging approaches, and assessments related to breast reconstruction. It applies to screening and a broad range of clinical presentations — e.g., nipple discharge, breast pain, suspected male breast cancer, evaluation in pregnant or lactating patients, high‑risk surveillance, and common benign findings. Major limitations/requirements include that advanced imaging typically requires a current clinical evaluation within 60 days (except screening), atypical presentations need physician review, Category 0 assessments must specify additional imaging, and the guideline content is proprietary to eviCore with restricted use.

"This tool addresses common symptoms and symptom complexes."