Does Medicare cover molecular breast imaging?

Coverage for Molecular Breast Imaging (MBI) There is no Medicare national coverage determination for MBI. There are currently no local Medicare contractors that have developed coverage policies for MBI. Coverage and reimbursement is at the payers discretion.

What does ultrasound breast code hold mean?

Breast tomosynthesis is an advanced form of mammography, a specific type of breast imaging that uses low-dose x-rays to detect cancer early when it is most treatable. Breast tomosynthesis is not yet available in all imaging facilities.

Is MRI necessary for breast cancer?

To screen for breast cancer: For certain women at high risk for breast cancer, a screening MRI is recommended along with a yearly mammogram. MRI is not recommended as a screening test by itself because it can miss some cancers that a mammogram would find.

What are the CPT codes for cancer scintigraphy?

Scintimammography and Breast Specific Gamma Imaging (BSGI): CPT codes not covered for indications listed in the CPB: 78195: Lymphatics and lymph nodes imaging: 78800: Radiopharmaceutical localization of tumor or distribution of radiopharmaceutical agent(s); limited area: 78801: multiple areas : 78803: tomographic (SPECT) 78804

How is scintigraphy used in the treatment of cancer?

Nuclear imaging is assuming an increasing role in the management of patients with cancer. Tumor scintigraphy involves the intravenous administration of a radio-pharmaceutical, defined as an isotope attached to a carrier molecule, which localizes in certain tumor tissues and the subsequent imaging and computer acquisition of data.

How big of a breast tumor can be detected by scintigraphy?

There is a lack of evidence in the medical literature demonstrating an acceptable level of sensitivity and specificity in detecting small, non-palpable breast lesions less than 1.2 cm]

What kind of tumor scintigraphy does Aetna use?

Aetna considers an OctreoScan, using octreotide (Sandostatin) tagged with radiolabeled 111Indium-pentetreotide, medically necessary for the diagnosis and staging of persons with primary and metastatic neuroendocrine tumors bearing somatostatin receptors.