New covered service for Texas Children’s Health Plan members | Texas Children's Health Plan

New covered service for Texas Children’s Health Plan members

02.26.2021
Dear Member,
 
We are pleased to announce that effective March 1, 2021, Digital Breast Tomosynthesis (DBT) will be a covered service of Texas Children’s Health Plan.
 
Screening Mammogram
 
Screening DBT, also known as three-dimensional (3D) mammography, provides 3D images and is a variation of a standard mammography. Screening DBT is used, along with standard screening mammography, to find breast changes in women who have no signs or symptoms of breast cancer. 
 
Diagnostic Mammogram
 
Diagnostic DBT is used, along with standard diagnostic mammography, to diagnose breast disease in women or men who have breast symptoms or findings on physical examination or screening mammogram.
 
Overview of DBT coverage
 
  • A screening DBT must be performed on the same member on the same date, by any provider, as a screening mammogram.
  • Screening DBT and standard screening mammogram procedures will be limited to one per year, by any provider.
  • A diagnostic DBT must be performed on the same member on the same date, by any provider, as a standard diagnostic mammogram, unilateral or bilateral.
  • A screening mammogram (DBT or standard) must be performed on the same member on the same date as a diagnostic mammogram (DBT or standard, unilateral or bilateral)
  • A mammogram may be indicated for a male member based on medical necessity due to existing signs and symptoms. In such rare circumstances, diagnostic mammogram (standard, unilateral or bilateral) and diagnostic DBT procedures may be considered for coverage.
 
If you have any questions about this new covered service, please contact Member Services at 1-866-959-6555 (CHIP), 1-866-959-2555 (STAR) or 1-800-659-5764 (STAR Kids).
 
Thank you for being our member.
Sincerely,
Texas Children's Health Plan