Beginning January 1, 2025, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) will cover breast MRIs for members with a diagnosis of dense breasts without the need for additional criteria to be met.
Effective January 1, prior authorization (PA) will NOT be required for Commercial and Medicare members for a breast MRI in the presence of dense breasts. Carelon Medical Benefits Management (Carelon) manages prior authorization for these services for Blue Cross NC.
If a provider calls Carelon with request for breast MRI and the member has a diagnosis of dense breasts, Carelon will respond that a breast MRI for this diagnosis does not require PA.
For questions contact the provider Blue Line at:
- Commercial: 800-214-4844
- Medicare: 888-296-9790
Blue Cross and Blue Shield of North Carolina does not discriminate on the basis of race, color, national origin, sex, age or disability in its health programs and activities. Learn more about our non-discrimination policy and no-cost services available to you.
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