Harvard Pilgrim Health Care Home
  HPHConnect
 
  Learn more.
  Sign up for HPHConnect.
Medical Management
E-Transactions
HPHConnect
Pharmacy
For Your Patient
News Center
Network Matters
Newsletter Archives
Newsletter Registration
Newsroom
Office Support
Products
Provider Manual
Medicare Advantage
Research & Teaching
Resources & Links
 
Print    Text Size

Network Matters
News and Information for the
Harvard Pilgrim Health Care Network

December 2016

Harvard Pilgrim Will Cover Screening 3D Mammography in Connecticut


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.

    Email this article to a colleague   


    Network Matters Archives

    Download printer-friendly version

    HPHCURRENT EVENTS

    New Opioid Safety Edits for Medicare and Commercial Plans

    CLINICIAN CORNER

    Update: New Coding for CT Screening for Lung Cancer

    Updates to Reimbursement for Moderate Sedation Services

    Harvard Pilgrim Will Cover Screening 3D Mammography in Connecticut

    Massachusetts Standard Form for Medication Prior Authorization Requests

    Updates to Prior Authorization Policy for Ilaris

    Medicare Prescriber Enrollment Deadline Updated

    Harvard Pilgrim Preferred Insulin Products on the Value Formulary

    Depression Screening and Potential Side Effects of Antidepressants

    OFFICE ASSISTANT

    Keep Panel Status and Demographic Information Up to Date

    PUBLICATION INFORMATION

    Eric H. Schultz,
    President and Chief Executive Officer

    Robert Farias,
    Vice President, Network Services

    Annmarie Dadoly,
    Editor

    Joseph O'Riordan,
    Writer

    Kristin Edmonston,
    Production Coordinator