Washington State Medicaid patients still denied 3D Mammography Coverage!

Governor Inslee signed SB 5912 mandating that 3D Mammography/Tomosynthesis  (CPT-77063) be “covered” under existing breast screening language effective 6/7/18 for all healthcare plans in Washington. However, for Washington State Medicaid patients this isn’t the case since 77063 is considered “bundled” with several other procedures. So, Governor Inslee gets credit for covering 3D Mammography, but this doesn’t apply to the lower-income Medicaid patients in the State of Washington!

CPT-77063 should be covered by all plans in the State of WA as a legitimate screening – with patient cost-sharing adjusted accordingly, but 77063, while “technically covered” by Medicaid has no allowable and is considered by the state as “bundled” into the screening with 77061, 77062. Many other states cover/pay for 77063 for the overall reduction in state spending for breast cancer as a result of earlier detection and reduced call-backs. 

 

Please contact Governor Inslee today and request that he start reimbursing for 3D Mammography screening for the Medicaid patients in the State of Washington! Lower-income Medicaid patients should be afforded the same standard of care mandated for all healthcare plans in the State of Washington.

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