Screening and Diagnostic Mammography & 3D Tomosynthesis Reimbursement Policy
Effective April 15, 2017, Horizon Blue Cross Blue Shield of New Jersey will change the way we reimburse certain claims for mammography screening and diagnostic services based on the guidelines of our reimbursement policy, Screening and Diagnostic Mammography & 3D Tomosynthesis
Beginning April 15, 2017, Horizon BCBSNJ will consider both a screening and a diagnostic mammography service for reimbursement when those services are rendered on the same date of service if the screening mammography procedure code is appropriately appended with Modifiers 59, XE or XU, and the diagnostic mammography procedure code is appropriately appended with Modifier GG.
We encourage you to review our Screening and Diagnostic Mammography & 3D Tomosynthesis reimbursement policy online.
Unless Horizon BCBSNJ provides notice that all or part of the changes noted in this reimbursement policy have been cancelled or postponed, the changes will be applied to claims for dates of service on and after April 15, 2017.
If you have questions, please call Physician Services at 1-800-624-1110 or our Institutional Services team at 1-888-666-2535, Monday through Friday, between 8 a.m. and 5 p.m., Eastern Time.
Our Screening and Diagnostic Mammography & 3D Tomosynthesis reimbursement policy defines a “mammographic episode of care” as a period of six months following the rendering of a previous screening or diagnostic mammography service.
This definition also applies to our Digital Breast Tomosynthesis medical policy, which states that “when digital breast tomosynthesis (DBT) is deemed eligible for coverage, it is limited to one procedure per mammographic episode of care, in either a screening or diagnostic role.”
Our Digital Breast Tomosynthesis medical policy may be reviewed within our Medical Policy Manual.