Breast Cancer Screening
Clinical Basis
Screening mammography is used for the early detection of breast cancer. One benefit of screening is that small tumors may be treated with less aggressive regimens than larger tumors.1
Common Exclusions
- Bilateral mastectomy
- Two unilateral mastectomies with service dates 14 days or more apart
- Absence of the left breast and absence of the right breast on the same or different dates of service
- Advanced illness and frailty
- I-SNP enrollment
- Hospice
- Palliative care
Clinical Guidelines
- The United States Preventive Services Task Force (USPSTF) recommends biennial screening mammography for women aged 50 to 74 years.2
- Ensure no prior authorization is required for mammography.
- Partner with radiology facilities to schedule mammograms.
Coding and Documentation Guidance
- The results of the screening mammography should be documented in the medical record.
- Any needed referrals or recommendations to patients for follow-up care (e.g., additional imaging, referrals to a surgeon for biopsy) should also be included.
- Document history of bilateral mastectomy to exclude patients from the denominator.
- Related Codes: 3014F - screening mammography results documented and reviewed.
1Institute of Medicine (US) and National Research Council (US) Committee on New Approaches to Early Detection and Diagnosis of Breast Cancer; Joy JE, Penhoet EE, Petitti DB, editors. “Saving
Women’s Lives: Strategies for Improving Breast Cancer Detection and Diagnosis”. Washington (DC): National Academies Press (US); 2005. “Benefits and Limitations of Mammography” (http://www.ncbi.nlm.nih.gov/books/NBK22311/)
2The USPSTF is a nationally recognized authority on preventive health (https://epss.ahrq.gov/ePSS/TopicDetails.do?topicid=198)
Associated Codes
3014F - Screening mammography results documented and reviewed
