Breast Imaging Guidelines

This policy covers breast imaging services — including mammography, breast ultrasound, breast MRI (with/without contrast and 3D rendering), imaging for reconstruction and implant evaluation — for common breast indications such as breast mass, nipple discharge/galactorrhea, mastodynia, suspected male breast cancer, pregnant/lactating patients, and transgender supplemental screening. Limitations: the clinical decision support tool applies only to common symptom complexes (atypical presentations require physician review); advanced imaging generally requires a current clinical evaluation and appropriate prior studies (mammogram/ultrasound/labs) though screening exams do not; MRI coding is restricted to CPT 77049/HCPCS C8908 for indicated bilateral MRI and CPT 77047 (without contrast) is supported only for implant integrity assessment when guideline indications are met.

"Suspected Breast Cancer in Males (BR-9)"