NC Medicaid Began Coverage of 3D Breast Tomography May 1

As of May 1, 2018, North Carolina Medicaid began covering digital breast tomosynthesis (3D tomosynthesis) for both screening and diagnostic mammography. Practices must submit claims with Healthcare Common Procedure Coding System (HCPCS) code G0279 (Diagnostic digital breast tomosynthesis, unilateral or bilateral) in addition to screening or diagnostic mammography Common Procedural Terminology (CPT) codes 77065-77067.

As reported earlier in the NCMS Bulletin, the North Carolina Medical Society (NCMS) and radiologists detailed the benefits of 3D mammography to the North Carolina Division of Medical Assistance. We are pleased the Medicaid program decided to begin covering breast tomosynthesis, or 3D mammography.

Using these higher quality images cuts down on the need for additional tests; help physicians detect more cancers earlier and especially helps detect tumors in women with dense breast tissue.

The North Carolina General Assembly passed legislation requiring physicians report when a woman has dense breast tissue to make them aware of the special benefits of 3D mammography in their particular case. Commercial insurers, like Blue Cross Blue Shield of North Carolina, does cover 3D mammography.

 
 

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