OLR Bill Analysis

sHB 5208 (as amended by House "A")*

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 breast tomosynthesis, including any procedure with one of 13 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 according to national guidelines.

*House Amendment “A” adds the following three billing codes to the definition of mammogram: 77065, 77066, and 77067.

EFFECTIVE DATE: January 1, 2019

MAMMOGRAM DEFINITION

The bill defines “mammogram” to include 13 HCPCS codes and any subsequent corresponding codes. Table 1 below lists the codes included in the bill with a description of what each covers.

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

77051

77065

77066

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

77052

77067

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

77055

Mammography; unilateral (one breast)

77056

Mammography; bilateral (both breasts)

77057

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

77063

Screening digital breast tomosynthesis, bilateral

G0202

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

G0204

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

G0206

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

G0279

Diagnostic digital breast tomosynthesis, unilateral or bilateral

COMMITTEE ACTION

Insurance and Real Estate Committee

Joint Favorable Substitute

Yea

21

Nay

0

(03/15/2018)

Appropriations Committee

Joint Favorable

Yea

52

Nay

0

(04/17/2018)