Breast Imaging - Medicare Advantage

This policy covers breast imaging services for Medicare Advantage beneficiaries, including screening and diagnostic mammography, breast sonography/echography, breast MRI, ductography, tomosynthesis‑guided biopsy and associated guidance procedures (e.g., MRI/ultrasound needle guidance), and related imaging modalities (PET, thermography, transillumination) as addressed by applicable CMS NCDs/LCDs. It applies to patients undergoing screening, diagnostic evaluation, monitoring of treatment or suspected/biopsy‑proven breast cancer and is subject to CMS/MAC jurisdictional LCDs, BI‑RADS management rules (Category 0 → additional imaging; Category 3 → short‑interval follow‑up; Categories 4–6 → tissue diagnosis), and specified billing/code and regional modifier limitations.

"Per NCD 220."

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