Breast Imaging for Screening and Diagnosing Cancer – Commercial and Individual Exchange Medical Policyopen_in_new

UnitedHealthcare covers screening breast MRI as medically necessary only for individuals meeting specific high‑risk criteria (prior chest radiation between ages 10–30 with screening from age 25 or 8 years after treatment, ≥20% lifetime risk by accepted models, personal history of breast cancer without bilateral mastectomy, specified pathogenic gene mutations with age‑to‑start guidance, or defined family‑history patterns including screening 10 years before the earliest relative but not before age 25); CT of the breast, MRE, tactile breast imaging, MRI for density alone, and molecular breast imaging (BSGI/PEM) are considered unproven and not medically necessary. Medical-record documentation may be required to demonstrate criteria are met and final coverage is determined by the member’s benefit plan and applicable mandates.

"Magnetic Resonance Imaging (MRI) of the breast for individuals who are high risk for breast cancer as defined as having any of the following:"