Diagnostic revert to Screening Mammography

caroline

Guru
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120
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Hello-

When does a non-Medicare patient who has had a previous diagnostic mammo return to being able to have a routine mammo. Is this determined by the radiologists recommendation? If a patient has fibrocystic breasts, are mammos always going to be diagnostic?

Thanks,
Caroline
 

donnajrichmond

True Blue
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Alexandria, LA
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The reason people quote Medicare policies is that non-Medicare payer policies are often non-existent, or hard to find. In addition, even within the same insurance group (such as Aetna), individual plans can make their own policies. So, there really is no way to answer a question about non-Medicare patients other than to say, you'll have to check the individual plan.

Having said that, ACR does have their recommendations that you can use as a basis (both for your policies and for appeals). You can look at the ACR practice guideline for mammography and also search on Coding Source for their mammo Q & As. However, since not even Medicare follow's all of ACR's recommendations, there is no guarantee than another payer will either.
 
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