Mammogram Coverage. We cover mammograms provided to a Member according to the schedule given below. Coverage is provided, subject to all the terms of this Contract, and the following limitations: We will cover:
Mammogram Coverage. We cover mammograms provided to a Member according to the schedule given below. Coverage is provided, subject to all the terms of this Contract, and the following limitations: We will cover: one baseline mammogram for a Member– who is 40 years of age one mammogram, every year, for a Member age 40 and older; and a mammogram at the ages and intervals the Member’s Practitioner deems to be Medically Necessary and Appropriate with respect to a Member who is less than 40 years of age and has a family history of breast cancer or other breast risk factors. In addition, if the conditions listed below are satisfied after a baseline mammogram We will cover: an ultrasound evaluation; a magnetic resonance imaging scan; a three-dimensional mammography; and other additional testing of the breasts. The above additional services will be covered if one of following conditions are satisfied. The mammogram demonstrates extremely dense breast tissue; The mammogram is abnormal within any degree of breast density including not dense, moderately dense, heterogeneously dense, or extremely dense breast tissue; or If the Member has additional risk factors of breast cancer including but not limited to family history of breast cancer, prior personal history of breast cancer, positive genetic testing, extremely dense breast tissue based on the Breast Imaging Reporting and Data System established by the American College of Radiology or other indications as determined by the Member’s Practitioner. Please note that mammograms and the additional testing described above when warranted as described above, are included under the Preventive Care provision. See also the following benefit for Digital Tomosynthesis.
