July 24, 2019
In 2018, the American Cancer Society® estimated that approximately 266,000 new cases of breast cancer in women were reported and approximately 41,000 of those resulted in mortality. The best defense for survival is early detection through screening. The United States Preventive Services Task Force recommends annual breast cancer screening, and in most patient situations, The National Comprehensive Cancer Network and the American Cancer Society agree.
Breast Cancer Screening is also a Healthcare Effectiveness Data and Information Set® (HEDIS) measure. Strategies for improvement include:
- Utilizing National Committee for Quality Assurance (NCQA) coding tips to actively reflect care rendered.
- Educating women about the importance of early detection and treatment starting at age 50.
- Referring women to local mammography imaging centers and following up to verify completion.
- Using reminder systems for check–ups and screenings.
The following is a chart for your review and easy access for designating mammography screening for early detection of breast cancer. For a complete list, please refer to the NCQA website.
Blue Cross and Blue Shield of Texas Federal Employee Program (FEP) members who are female and 40 years old and older are eligible for one breast cancer screening per calendar year as a covered benefit. Mammography screenings are part of the FEP’s Preventive Care Benefits and are recognized by the plan on the first claim processed in a calendar year, regardless of when in the previous calendar–year the screening exam was performed. Preventive Care Benefits include unilateral or bilateral mammography screening or Digital Breast Tomosynthesis screening.
Thank you for your dedication to ensure that all your patients including FEP members receive exceptional care.
If you have any questions regarding FEP patients, please do not hesitate to reach out to the Federal Employee Quality Improvement Program.
The above material is for informational purposes only and is not intended to be a substitute for the independent medical judgment of a physician. Physicians and other health care providers are encouraged to use their own best medical judgment based upon all available information and the condition of the patient in determining the best course of treatment.