Effective June 1, 2017, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) will expand coverage for our commercially insured members to include digital breast tomosynthesis, also known as 3D mammography. 3D mammography benefits will be covered for breast cancer screening similarly to the way full-field digital mammography (also known as 2D mammography) services are covered.
Members’ costs for these services will vary, based on their individual benefit plans. Additionally, for health plans that cover preventive services at 100%, 3D mammography screening services will be covered at no member cost.
Blue Cross NC recognizes 3D mammography is becoming a more prevalent medical service. Members enrolled in the Federal Employee Program, Blue Cross NC’s Medicare Advantage products, and some self-insured, large employer group plans already have coverage for this service. Making this change will help give our commercially insured members and their doctors the same choice in screening and diagnostic services.
Starting June 1, 2017, Blue Cross NC will no longer consider digital breast tomosynthesis to be “investigational” in the screening or diagnosis of breast cancer. Benefits eligibility will become available on June 1, 2017, for 3D mammography services performed on dates beginning June 1, 2017. This applies to members enrolled in Blue Cross NC’s commercially offered products, administrative services only products, and the North Carolina State Health Plan.
Members from other Blue Cross and or Blue Shield Plans may or may not have coverage for 3D mammography services.
Providers should verify a member’s individual eligibility and benefits before providing any non-emergency test, procedure or service.
Blue Cross NC’s current 3D mammography medical policy will be archived on June 1, 2017 and will no longer be accessible for viewing.