3-D Mammography Preventive Service Mandate

July 26, 2018

On January 16, 2018, the state of New Jersey enacted a new benefit mandate that requires health insurance coverage without cost sharing for digital tomosynthesis (three-dimensional or 3-D mammography) to detect or screen for breast cancer in women age 40 years and older. This new mandate is effective for fully insured plans and the State Health Benefits Program issued or renewed on or after August 1, 2018.

Digital tomosynthesis creates a three-dimensional picture of the breast using several low-dose X-ray images from different angles as the scanner moves in an arc around the breast. Conventional mammography produces one image of overlapping tissue. The difference between the images produced by tomosynthesis and conventional mammography has been described as being similar to a ball (3-D) versus a circle (flat).

One preventive 3-D mammography and one preventive conventional mammography are covered during each benefit year. However, if a mammography is provided for diagnostic purposes in women of any age, then cost sharing may apply.