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New Information

Breast and Cervical Reimbursement Rates Updated for 2015

BreastCare has updated the reimbursement amounts for covered procedures for 2015. Additional updates such as adding new codes and deleting discontinued codes will be completed by May 18, 2015. The updated reimbursement rate tables can be found under Billing Information and Manuals on theForms and Manuals page. A link to this page is provided at the top of this page.

MRI Now Covered Under Certain Conditions

Magnetic Resonance Imaging (MRI) procedures (77058 and 77059) can now be performed for BreastCare patients under certain conditions. A breast MRI should only be performed in conjunction with a mammogram for women with a higher risk. This includes women with a BRCA mutation, a first –degree relative who is a BRCA carrier or a lifetime risk of 20% or greater as defined by risk assessment models. A breast MRI can also be used to better assess areas of concern on a mammogram or for evaluation of a patient with a past history of breast cancer. A breast MRI should never be done alone as the only breast screening procedure.

Virtual Training Opportunities on BreastCare Billing:

Do you or your staff have questions about BreastCare billing policy, the claim submission process, or Provider Electronic Solutions (PES) software? Are you unable to travel to BreastCare training workshops held throughout the year at various locations? Then a virtual training workshop is for you! Now you can attend a class without leaving your office. The Arkansas Department of Health and HP Enterprise Services invite you to attend useful classes in an Internet virtual classroom environment. The classes are designed to help you:

  • configure software for prompt and accurate billing
  • understand fundamentals of the claim submission process, issues surrounding claim denials and actions you can take to prevent future denials
  • Set-up and use PES to submit claims
  • register for and use WebRA

Click here to view and register for upcoming classes. For questions, contact Karen Young at kareny@hp.com.

Claim Denial

If your claim is denied, verify that your claim contains correct NPI number, performing provider taxonomy (if it exists), and appropriate office visit procedure code and that the on-line BreastCare system contains the matching patient ID, date of service, exam type and procedure results (CBE, Pap test, if applicable and/or mammogram) and re-file claim.  For questions contact 1-855-661-7830.

Ultrasound Required for Palpable mass

Breast ultrasound and diagnostic mammogram must be ordered per BreastCare policy in the presence of a palpable mass. These procedures should be done on the same day for the convenience of the patients and to decrease delay in diagnosis. If the ultrasound is not performed when ordered, the patient will be rescheduled at the same facility for the procedure.  The patient must be referred for a surgical consultation unless the ultrasound reveals a cyst or benign abnormality.

Referrals to Arkansas Tobacco Quitline

The smoking status of all BreastCare clients must be reported to BreastCare on the Screening Form.  Current smokers should be referred to 1-800-Quit-NOW (1-800-784-8669 for assistance to quit smoking.  

Archived Information

Archived Provider Information