Mammography Services. This Agreement provides coverage for low-dose screening mammograms for determining the presence of breast cancer. This coverage makes available one baseline mammogram to persons age 35-39, one mammogram biennially to persons age 40-49, and one mammogram annually to persons age 50 and over. After July 1, 1992, coverage shall be available only for screening mammograms obtained on equipment designed specifically to perform low-dose mammography in imaging facilities that have met American College of Radiology accreditation standards for mammography. These scans are Covered. Pre-Exposure Prophylaxis Coverage Summary Pre-Exposure Prophylaxis (PrEP) Your plan includes coverage for PrEP medication, as appropriate for you, and essential PrEP- related services without cost sharing, the same as any other preventive drug or service. This means that you do not have to make a copayment, pay coinsurance, satisfy a deductible or pay out-of-pocket for any part of the benefits and services listed in this summary if you receive them from an in-network provider. You may be required to pay a copay, coinsurance, and/or a deductible if you receive PrEP medication or PrEP-related services from an out-of-network provider if the same benefit or service is available from an in-network provider. What is Covered? • At least one FDA-approved PrEP drug, with timely access to the PrEP drug that is medically appropriate for the enrollee, as needed • HIV testing • Hepatitis B and C testing • Creatinine testing and calculated estimated creatine clearance or glomerular filtration rate • Pregnancy testing for individuals with childbearing potential • Sexually transmitted infection screening and counseling • Adherence counseling • Office visits associated with each preventive service listed above • Quarterly testing for HIV and STIs, and annually for renal functions, required to maintain a PrEP prescription.
Mammography Services. This Section 3.6 is only applicable during the period January 1, 2001, through December 31, 2001. Medical Group shall receive *** for each screening and diagnostic mammography study performed above the 1987 PacifiCare wide baseline, specific to the PacifiCare commercial program, for such studies. (This baseline equals ninety (90) studies per one thousand (1,000) adult females per Year.)
Mammography Services. This agreement provides coverage for low-dose screening mammograms for determining the presence of breast cancer. This coverage makes available one baseline mammogram to persons age 35-39, one mammogram biennially to persons age 40-49, and one mammogram annually to persons age 50 and over. After July 1, 1992, coverage shall be available only for screening mammograms obtained on equipment designed specifically to perform low-dose mammography in imaging facilities that have met American College of Radiology accreditation standards for mammography. These scans are covered. Additionally, medically necessary and clinically appropriate diagnostic breast examinations using diagnostic mammography, breast magnetic resonance imaging, or breast ultrasound that evaluates an abnormality seen or suspected from a screening examination for breast cancer; or detected by another means of examination and medically necessary and clinically appropriate supplemental breast examinations using breast magnetic resonance imaging or breast ultrasound that is used to screen for breast cancer when there is no abnormality seen or suspected; and based on personal or family medical history or additional factors that may increase the individual's risk of breast cancer are covered.
Mammography Services. 9.02 Billing for Non-Capitated Services shall be as follows:
Mammography Services. 4 CONTRACTOR will conduct on-site bilateral screening mammography exams 5 to participants of the SJVIA at various locations and over multiple days for Participating Entities as 6 mutually agreed upon between CONTRACTOR and Participating Entity. 7 8 CONTRACTOR may only schedule mammography services with a 9 Participating Entity after receiving written approval from the SJVIA Manager, SJVIA Assistant 10 Manager, or designee to ensure that the Participating Entity is able to schedule the minimum 11 number of required exams as set forth in Exhibit B. Such services should be scheduled by the 12 Participating Entity at least 45 days in advance of services unless mutually agreed upon by 13 Participating Entity and CONTRACTOR. Upon receiving SJVIA approval, CONTRACTOR shall 14 work directly with Participating Entity to schedule actual dates and locations of mammography 15 services. 16 17 CONTRACTOR shall provide a notice of privacy practices to each participant 18 before conducting the bilateral screening mammography exam. 19 20 The bilateral screening mammography exam shall result in a written report, 21 including interpretation, by the radiologist who performed the exam. The report shall be sent to the 22 participant’s designated physician within 5-7 working days after the day of service.
