Providers: New Information | Professional Development |Forms & Manuals | Clinical Guidelines | Provider Enrollment | Frequently Asked Questions
BreastCare Expands Eligibility for Pap Testing and Diagnostic Services
The BreastCare program has revised eligibility guidelines to expand coverage. The revised guidelines include expanding the age range for cervical cancer screening and diagnostic services and providing diagnostic services for underinsured (insured but meet financial criteria) women who qualify. BreastCare now covers Pap testing for uninsured women between 21 and 39 years old as well as any diagnostics and follow up needed as a result of an abnormal screening. Diagnostic services may also be covered for those who are insured but need assistance with co-pays, co-insurance or deductibles. For questions about these new guidelines, please contact your Regional Care Coordinator.
Breast and Cervical Reimbursement Rates Updated for 2017
BreastCare has updated the reimbursement amounts for covered procedures for 2017. The updated reimbursement rate tables can be found under Billing Information and Manuals on the Forms and Manuals page.
BreastCare Now Covers 3D Mammography
The Breast Care program now covers 3D mammography (tomosynthesis) as a reimbursable procedure as of October 1, 2016. BreastCare is uses the following CMS guidance for Medicare reimbursement instructions for billing the following codes:
• 77063 should be listed as a separate code in addition to the code for the primary mammogram code, 77057 or G0202. Do not report this code with 77055 or 77056.
• G0279 should be listed as a separate code in addition to G0204 or G0206 for the primary mammogram.
• The codes 77061 and 77062 are not allowed as they are not approved by Medicare.
BreastCare Announces Expanded Eligibility to Reach More Women
BreastCare recently expanded its eligibility by increasing income to 250% of the Federal Poverty Level and offering breast diagnostic services to women under 40 who are symptomatic. While these changes have only been in effect for a short time, they have already proven successful in helping more women receive screening and diagnostic services and have resulted in cancer being detected and treated. For questions or more information about these changes, please contact BreastCare or your Regional Care Coordinator.
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 firstname.lastname@example.org
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 InformationArchived Provider Information