Wellmark Will Now Provide Coverage for 3-D Mammograms

Effective for claims processed on or after Sept. 15, 2016, digital breast tomosynthesis (3-D mammogram) is no longer considered investigational and will be a covered as a standard contract benefit under Wellmark coverage. 

Why is Wellmark making this change?
The National Comprehensive Cancer Network (NCCN), who Wellmark uses to aid in the determination of the standard of care for cancer treatment, has recently issued a revision to its recommendation for breast cancer screening. The new recommendation from NCCN is that combined use of digital mammography and breast tomosynthesis appears to improve cancer detection and recall rates. The addition of tomosynthesis to digital mammography is more commonly known as 3D mammography. Accordingly, Wellmark’s Medical Policy team has decided to retire current medical policy where the 3D portion of the mammogram is considered investigational.

How will this change impact Wellmark members?
After Sept. 15, 2016, digital breast tomosynthesis (3-D mammogram) will be considered a covered benefit under Wellmark coverage. Member cost share will be waived for claims submitted as a routine mammogram. For claims submitted with a medical diagnosis, member cost share will apply. 

If you have any questions, contact Juliette Houseman, Benefits Specialist, at ext. 14315.