October 2021

Breast Cancer Screening

To support quality care, we are providing information to providers and members to encourage discussions on health topics. Watch for more on health care quality in News and Updates.

Breast cancer is the second leading cause of death among women in the U.S., according to the Centers for Disease Control and Prevention (CDC). About 1 in 8 women will get breast cancer at some point in her life. We encourage providers to talk with our members about the importance of regular screenings for women. We’ve created some resources that may help. Screening is the best way to find breast cancer early, when it’s easier to treat, and may help reduce the risk of death.

Closing Care Gaps
The U.S. Preventive Services Task Force recommends that women ages 50 to 74 be screened for breast cancer every two years. You may want to discuss with members the risks and benefits of starting screening mammograms before age 50.

Breast cancer screening is also a Healthcare Effectiveness Data and Information Set (HEDIS^®) measure from the National Committee for Quality Assurance (NCQA). The measure tracks women ages 50 to 74 who had at least one mammogram in the past two years.

See our preventive care guidelines on breast cancer screening.

Tips to Consider

Talk with our members about breast cancer risk factors and regular screenings for women.
Document screenings in the medical record. Indicate the specific date and result.
Document medical and surgical history in the medical record, including dates.
Document legibly, clearly and concisely, how each diagnosis was monitored, evaluated, assessed and/or treated on the date of service.
Ensure a credentialed provider signs and dates all documents.
Use correct diagnosis and procedure codes. Submit claims and encounter data in a timely manner.
For men who are at high risk , the American Cancer Society recommends discussing with them how to manage risks.

The above material is for informational purposes only and is not a substitute for the independent medical judgment of a physician or other health care provider. Physicians and other health care providers are encouraged to use their own medical judgment based upon all available information and the condition of the patient in determining the appropriate course of treatment. The fact that a service or treatment is described in this material is not a guarantee that the service or treatment is a covered benefit and members should refer to their certificate of coverage for more details, including benefits, limitations, and exclusions. Regardless of benefits, the final decision about any service or treatment is between the member and their health care provider.

HEDIS is a registered trademark of NCQA.

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