News
Ambetter Authorization Requirement for Digital Breast Imaging
Date: 10/10/17
Ambetter from Superior HealthPlan understands the importance of easy access to quality care and is committed to ensuring preventive services continue to be appropriate and efficient. To align with this goal, Ambetter is now covering Digital Breast Imaging (DBI) without a prior authorization for both preventive and diagnostic purposes.
Effective September 1, 2017, digital breast imaging/mammography has been included in Ambetter covered benefits.
The codes affected by this change include:
| CPT Codes | Description |
|---|---|
| 77061 | Digital Breast tomosynthesis; unilateral |
| 77062 | Digital Breast tomosynthesis; bilateral |
| 77063 | Screening digital breast tomosynthesis; bilateral |
| HCPCS Codes | Description |
|---|---|
| G0279 | Diagnostic digital breast tomosynthesis; unilateral or bilateral |
When administered as a preventive screening, this benefit is subject to the annual screening limit, and cost shares do not apply. If digital breast imaging services are provided for diagnostic purposes outside of the annual screening, they still will not require prior authorization, but will be subject to member’s applicable cost share.
If you have any questions, please reach out to your local Account Manager or Provider Services at 1-877-687-1196.