Breast Imaging Guidelines

This policy governs breast imaging services—including screening and diagnostic mammography, breast ultrasound, MRI breast (supported codes such as CPT 77049/HCPCS C8908 and limited use of CPT 77047 for implant integrity), 3D rendering, and related modalities—for evaluation of breast symptoms and surveillance. It applies to common symptom scenarios and key populations (e.g., individuals with breast implants, suspected male breast cancer, pregnant or lactating patients, and transgender supplemental screening) and requires a current clinical evaluation since symptom onset before advanced imaging (not required for routine screening); atypical presentations not addressed by the tool require physician review and routine standalone ultrasound screening is not supported.

"See Breast Ultrasound (BR-1)"

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