In June 2015, Connecticut passed legislation that requires health plans in the state to cover 3D mammography, also known as digital breast tomosynthesis, as of January 1, 2017. As opposed to traditional mammography, which obtains a single image, 3D mammography takes multiple images of breast tissue to create a 3D picture of the breast.
In compliance with this new legislative requirement, effective January 1, Harvard Pilgrim will cover screening 3D mammography for members of our Connecticut plans. In addition to 2D screening and diagnostic services, which will remain covered in all states, providers in Connecticut may now bill for the add-on CPT code 77063 – Screening digital breast tomosynthesis, bilateral (list separately in addition to code for primary procedure).
Screening 3D mammography will remain uncovered in all other states. Additionally, coverage for the following codes will remain the same; Harvard Pilgrim will not reimburse for diagnostic 3D mammography in any states.
- 77061 – Digital breast tomosynthesis; unilateral
- 77062 – Digital breast tomosynthesis; bilateral
- G0279 – Diagnostic digital breast tomosynthesis, unilateral or bilateral
For more information, refer to Harvard Pilgrim’s 3D Mammography Medical Policy.