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New Information

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 2016

BreastCare has updated the reimbursement amounts for covered procedures for 2016. The updated reimbursement rate tables can be found under Billing Information and Manuals on the  Forms and Manuals page.

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 virtual.trainer@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