Coding of Screening Mammograms

On Oct. 4, 2017, the Vermont Division of Insurance published Insurance Bulletin No. 195. The new bulletin relates to coding of screening mammograms. According to the bulletin, Vermont law states that insurers must provide coverage for screening by mammography for the presence of occult breast cancer, and that those benefits must cover the full cost of the mammography service (without being subject to any copayment, deductible, coinsurance or other cost-sharing). “Screening” for this purpose includes the mammography test procedure and a qualified physician’s interpretation of the results of the procedure. The bulletin states that there have been cases where screenings have been coded by providers and carriers so as to result in a financial obligation for the covered individual. The bulletin reminds carriers and providers to coordinate so as to ensure that the cost-sharing (financial obligation) does not occur for the covered individual.

The bulletin contains no new employer obligations, but serves as a helpful reminder on mammography coverage and as a potential source of information should employees have questions regarding such coverage.

Insurance Bulletin No. 195 »