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Medical Policy Revision: Computer-Aided Evaluation of Malignancy with MRI of the Breast

Effective August 1, 2017, Horizon Blue Cross Blue Shield of New Jersey will change the way we consider claims for the use of computer-aided evaluation (CAE) for interpretation of magnetic resonance imaging (MRI) of the breast.

Our revised medical policy, Computer-Aided Evaluation of Malignancy with MRI of the Breast, identifies when the use of CAE for interpretation of MRI of the breast is considered investigational.

We encourage you to review this policy in our Medical Policy Manual.


Based on the guidelines of our revised medical policy, Computer-Aided Evaluation of Malignancy with MRI of the Breast, CPT code +0159T submitted on claims for services provided on and after August 1, 2017 to members enrolled in Administrative Services Only (ASO) health insurance plans that have NOT elected to participate in our Radiology Imaging Program managed by eviCore healthcare will be denied as an experimental/investigational service regardless of the submitted diagnosis code(s).

Unless Horizon BCBSNJ gives written notice that all or part of the above changes have been cancelled or postponed, the changes will be applied to claims for dates of service on and after August 1, 2017.

CPT® is a registered mark of the American Medical Association.

Published on: April 27, 2017, 13:40 p.m. ET
Last updated on: April 27, 2017, 13:52 p.m. ET