Breast Imaging Guidelines

This policy covers breast imaging services including screening and diagnostic mammography, breast ultrasound, breast MRI (and MRI‑guided biopsy/CAD), reconstruction imaging, and BI‑RADS‑based reporting. It applies to symptomatic and screening populations (e.g., nipple discharge, breast pain, suspected male breast cancer, post‑mastectomy imaging) but requires physician review for atypical presentations, limits routine ultrasound screening for density alone, follows BI‑RADS‑guided actions (Category 3 short‑interval follow‑up at 6/12/18/24 months, Category 4 consideration of biopsy), generally favors bilateral MRI unless clinically justified, and includes procedural, billing, and state density‑reporting requirements (e.g., prior mammogram timelines and specific CPT coding).

"These lesions have been biopsied and are known to be malignant."

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