![]() ![]() CPB 0517 - Breast Ductal Lavage and Fiberoptic Ductoscopy.CPB 0105 - Magnetic Resonance Imaging (MRI) of the Breast.CPB 0071 - Positron Emission Tomography (PET).Use of the MarginProbe for intra-operative margin assessment during breast surgery.Use of magnetic seeds (e.g., Magseed), and the SAVI SCOUT surgical guidance system during localized excisional biopsy or lumpectomy.Three-dimensional (3D) volumetric imaging and reconstruction of breast or axillary lymph node tissue.Other minimally invasive image-guided breast biopsy procedures (i.e., those not mentioned above) (e.g., PET-guided breast biopsy (Naviscan)).The following procedures are considered experimental and investigational because the effectiveness of these approaches has not been established: Vacuum assisted core-needle biopsy (Mammotome™ device).Īetna considers digital breast tomosynthesis-guided breast biopsy an equally acceptable alternative to mammographically guided biopsy for medically necessary indications.Ultrasound-guided core-needle biopsy or.Stereotactically guided core-needle biopsy or.Radioactive seed localization (RSL) or radio-guided occult lesion localization (ROLL) of non-palpable breast lesions for locating lesions to guide excisional biopsy or breast-conserving surgery or.Advanced Breast Biopsy Instrument (ABBI) or.This Clinical Policy Bulletin addresses breast biopsy procedures.Īetna considers any of the following minimally invasive image-guided breast biopsy procedures medically necessary as alternatives to needle localization core surgical biopsy (NLBx) in members with abnormalities identified by mammography that are non-palpable or difficult to palpate (i.e., because they are deep, mobile, small (less than 2 cm), or are composed of clustered microcalcifications): Number: 0269 Table Of Contents Policy Applicable CPT / HCPCS / ICD-10 Codes Background References ![]()
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