Why are Breast Cancer Screenings Important?
To support quality care, we are providing information to providers and members to encourage discussions on health topics. Watch for more on health care quality in News and Updates and our Wellness Can't Wait web page.
Regular breast cancer screening helps detect breast cancer early when it is most treatable.
Except for some forms of skin cancer, breast cancer is the most common cancer among American women, regardless of race or ethnicity. Screening can improve outcomes. Early detection reduces the risk of dying from breast cancer and can lead to a greater range of treatment options and lower health care costs. Learn more from the Centers for Disease Control and Prevention (CDC) .
Closing Care Gaps
We've created a Breast Cancer Screen Tip Sheet that captures this HEDIS measure. The National Committee for Quality Assurance (NCQA) uses the following criteria for breast cancer screenings:
- Women ages 50 to 74
- Screening mammograms at least every two years
- Breast cancer screening (BCS) with one of the follow methods of mammography:
- Digital Breast Tomosynthesis
- Biopsies, breast ultrasounds or MRIs may be indicated for higher risk patients or for diagnostic purposes (as an adjunct to mammography) but not as a substitute for mammography
View our preventive care guidelines on breast cancer screenings.
Best Practices to Consider
- Educate our members about the importance of early detection and encourage testing
- Document a bilateral mastectomy in the medical records when applicable
- Have a list of in-network mammogram facilities available to share with our members
- Discuss possible fears our members may have about mammograms
- Include the month and year of the date of service when documenting a mammogram
Best practices also include using the proper codes when filing claims. Proper coding can help identify gaps in care, provide accurate data and streamline your administrative processes.
Reference and review the Texas Medicaid resources for BCBSTX Preventive Care Guidelines (PCGs), Clinical Practice Guidelines (CPGs) and THSteps for Medical Providers which includes all current vaccine schedules, ImmTrac2 and other important guidance for treating your patients.
The above material is for informational purposes only and is not a substitute for the independent medical judgment of a physician or other health care provider. Physicians and other health care providers are encouraged to use their own medical judgment based upon all available information and the condition of the patient in determining the appropriate course of treatment. The fact that a service or treatment is described in this material is not a guarantee that the service or treatment is a covered benefit and members should refer to their certificate of coverage for more details, including benefits, limitations and exclusions. Regardless of benefits, the final decision about any service or treatment is between the member and their health care provider.
HEDIS is a registered trademark of the NCQA.