New Information

Please be aware of new information recently provided to BreastCare providers regarding testing, covered procedures and codes.

Effective December 5, 2009

BreastCare coverage for women will no longer be retroactive 30 days preceding the enrollment date. Thus, we ask providers to be sure you see the patient’s current enrollment card or that you call the enrollment center at 1-877-670-2273 to be sure the patient is enrolled before providing any service. Any service provided prior to the patient’s enrollment date will not be covered including, but not limited to, mammograms and office visits.

Surgical Follow-Up

BreastCare patients may receive follow-up after a mammographic abnormality or benign biopsy for one year. After one year patients go back into annual screening with their Primary Care Providers (PCP). The cycle starts over with another mammogram. Any time that the mammogram is abnormal the patient may receive a biopsy or be referred back to the surgeon if appropriate. An annual visit to the PCP is important. In addition to breast screening, patients receive a Pap test every two (2) years per BreastCare policy.

Category 0 – Need additional imaging evaluation and/or prior mammograms for comparison

BreastCare is now required by CDC to track mammograms with Category 0 that need additional imaging separately from mammograms with Category 0 that require prior films for comparison. BreastCare is responsible for reporting if the comparison with prior films was made and the final imaging outcome. Please help by clearly indicating on the mammogram report if prior films have been requested for comparison.

Physician Orders for Diagnostic Mammograms

BreastCare clients are required to have Physician Orders for diagnostic mammograms. When a client arrives at the mammography facility for her appointment without a Physician Order, the facility will call the provider to request an order. Please fax the order ASAP. The patient will be waiting and may not understand why she has to wait so long or even why her mammogram cannot be performed at all. Please remember to fax the order when a mammogram is scheduled. This will save time and prevent conflict between the provider and the patient.

Revised BreastCare Physician Order

Both ultrasound and diagnostic mammogram are required and should be ordered when a patient is referred for a palpable mass. The BreastCare Physician Order has been revised to include orders for breast ultrasound and diagnostic mammogram in the presence of a palpable mass. These procedures should be done on the same day for the convenience of the patients and to decrease delay in diagnosis. If the ultrasound is not performed when ordered, the patient will be sent back to the facility for the procedure. You may call (501) 661-2636 to obtain a copy of the BreastCare Physician Order.