OLR Bill Analysis

sHB 5208

AN ACT CONCERNING MAMMOGRAMS, BREAST ULTRASOUNDS AND MAGNETIC RESONANCE IMAGING OF BREASTS.

SUMMARY

This bill expands coverage for mammograms and tomosynthesis under certain health insurance policies. It does so by defining “mammogram” as a mammographic examination or tomosynthesis, including any procedure with one of 10 specific Healthcare Common Procedure Coding System (HCPCS) billing codes or any subsequent corresponding codes.

The bill applies to individual and group health insurance policies delivered, issued, renewed, amended, or continued in Connecticut that cover (1) basic hospital expenses; (2) basic medical-surgical expenses; (3) major medical expenses; or (4) hospital or medical services, including those provided under an HMO plan. It also applies to individual policies providing limited health benefits.

By law, such policies must cover baseline mammograms for women age 35 through 39, and annual mammograms for women age 40 or older. The federal Affordable Care Act prohibits certain health insurance policies from imposing copays or deductibles for mammograms conducted in accordance with national guidelines.

EFFECTIVE DATE: January 1, 2019

MAMMOGRAM DEFINITION

The bill defines “mammogram” to include 10 HCPCS codes and any subsequent corresponding codes. However, at least some of the 10 HCPCS codes listed in the bill are inactive. Table 1 below lists the 10 codes included in the bill and any subsequent codes.

HCPCS is a set of billing codes used by Medicare and overseen by the federal Centers for Medicare and Medicaid Services. They are based on current procedural technology codes developed by the American Medical Association.

Table 1: HCPCS Codes for Mammograms

Code Listed In Bill

Description

Subsequent Code

77051

Computer-aided detection (computer algorithm analysis of digital image data for lesion detection) with further review for interpretation, with or without digitization of film radiographic images; diagnostic mammography

77065 (unilateral)

77066 (bilateral)

77052

Computer-aided detection with further review for interpretation, with or without digitization of film radiographic images; screening mammography

77067

77055

Mammography; unilateral (one breast)

77065

77056

Mammography; bilateral (both breasts)

77066

77057

Screening mammography, bilateral (2-view study of each breast)

77067

77063

Screening digital breast tomosynthesis, bilateral

None

G0202

Screening mammography, producing direct digital image, bilateral, all views

None

G0204

Diagnostic mammography, including computer-aided detection when performed; bilateral

None

G0206

Diagnostic mammography, including computer-aided detection when performed; unilateral

None

G0279

Diagnostic digital breast tomosynthesis, unilateral or bilateral

None

COMMITTEE ACTION

Insurance and Real Estate Committee

Joint Favorable Substitute

Yea

21

Nay

0

(03/15/2018)